Provider Demographics
NPI:1609849405
Name:GRIMM, DAVID Y (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:Y
Last Name:GRIMM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 HOWELL BRANCH RD
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1109
Mailing Address - Country:US
Mailing Address - Phone:407-644-2121
Mailing Address - Fax:407-644-2974
Practice Address - Street 1:1555 HOWELL BRANCH RD
Practice Address - Street 2:SUITE B-4
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1109
Practice Address - Country:US
Practice Address - Phone:407-644-2121
Practice Address - Fax:407-644-2974
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist