Provider Demographics
NPI:1578559498
Name:GRIMES, JAN LYNN (RN,NP,LPC)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:LYNN
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RN,NP,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N HAMPTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8300
Mailing Address - Country:US
Mailing Address - Phone:214-502-6942
Mailing Address - Fax:214-351-2884
Practice Address - Street 1:1510 N HAMPTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8300
Practice Address - Country:US
Practice Address - Phone:214-502-6942
Practice Address - Fax:214-351-2884
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236780163WP0808X
TX12493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health