Provider Demographics
NPI:1821155540
Name:GRIMSLEY, GLENNA GAINES (LPC)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:GAINES
Last Name:GRIMSLEY
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 1:4108 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-7313
Mailing Address - Country:US
Mailing Address - Phone:325-646-9574
Mailing Address - Fax:325-641-1872
Practice Address - Street 1:4108 9TH ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-7313
Practice Address - Country:US
Practice Address - Phone:325-646-9574
Practice Address - Fax:325-641-1872
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional