Provider Demographics
NPI:1568126167
Name:GRIMM, KENDALL GAY (LPC)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:GAY
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SHOSHONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2462
Mailing Address - Country:US
Mailing Address - Phone:281-299-8053
Mailing Address - Fax:
Practice Address - Street 1:20351 HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3882
Practice Address - Country:US
Practice Address - Phone:979-233-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional