Provider Demographics
NPI:1437124781
Name:GRIMM, TODD L (MS LPC, CAC DIPLOMAT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:L
Last Name:GRIMM
Suffix:
Gender:M
Credentials:MS LPC, CAC DIPLOMAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 W CHESTER PIKE
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4877
Mailing Address - Country:US
Mailing Address - Phone:610-429-4100
Mailing Address - Fax:610-429-1570
Practice Address - Street 1:999 W CHESTER PIKE
Practice Address - Street 2:SUITE B-1
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4877
Practice Address - Country:US
Practice Address - Phone:610-429-4100
Practice Address - Fax:610-429-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4510101YA0400X
PAPC000237101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)