Provider Demographics
NPI:1730469636
Name:GRIMM, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S COLORADO BLVD
Mailing Address - Street 2:SUITE 860
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1253
Mailing Address - Country:US
Mailing Address - Phone:303-322-9000
Mailing Address - Fax:303-322-9001
Practice Address - Street 1:400 S COLORADO BLVD
Practice Address - Street 2:SUITE 860
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1253
Practice Address - Country:US
Practice Address - Phone:303-322-9000
Practice Address - Fax:303-322-9001
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0433476101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool