Provider Demographics
NPI:1548416712
Name:GRIMM, ANNA DIANNE (MA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:DIANNE
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 VETERANS DRIVE
Mailing Address - Street 2:SUITE124
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4564
Mailing Address - Country:US
Mailing Address - Phone:231-043-7312
Mailing Address - Fax:231-943-5105
Practice Address - Street 1:3301 VETERANS DRIVE
Practice Address - Street 2:SUITE 124
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4564
Practice Address - Country:US
Practice Address - Phone:231-943-7312
Practice Address - Fax:231-943-5105
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist