Provider Demographics
NPI:1417967811
Name:GRIMES, MICHAEL J (M A)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:GRIMES
Suffix:
Gender:M
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 E 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-3701
Mailing Address - Country:US
Mailing Address - Phone:816-554-5535
Mailing Address - Fax:816-554-5550
Practice Address - Street 1:6801 E 117TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-3701
Practice Address - Country:US
Practice Address - Phone:816-554-5535
Practice Address - Fax:816-554-5550
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01788103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist