Provider Demographics
NPI:1477990018
Name:GEORGE P. GRIMES, PHD, PA
Entity Type:Organization
Organization Name:GEORGE P. GRIMES, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-417-4294
Mailing Address - Street 1:480 MARINERS DR
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2261
Mailing Address - Country:US
Mailing Address - Phone:979-417-4294
Mailing Address - Fax:281-538-8069
Practice Address - Street 1:480 MARINERS DR
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2261
Practice Address - Country:US
Practice Address - Phone:979-417-4294
Practice Address - Fax:281-538-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty