Provider Demographics
NPI:1518056415
Name:GRIMES, LAURIE MOUNT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MOUNT
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1838
Mailing Address - Country:US
Mailing Address - Phone:502-596-1073
Mailing Address - Fax:502-596-1413
Practice Address - Street 1:1100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1838
Practice Address - Country:US
Practice Address - Phone:502-596-1073
Practice Address - Fax:502-596-1413
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1156103TC2200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent