Provider Demographics
NPI:1851567069
Name:GEORGE P GRIMES PHD
Entity Type:Organization
Organization Name:GEORGE P GRIMES PHD
Other - Org Name:GEORGE P GRIMES PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-417-4294
Mailing Address - Street 1:1345 SPACE PARK DR
Mailing Address - Street 2:STE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3469
Mailing Address - Country:US
Mailing Address - Phone:979-417-4294
Mailing Address - Fax:281-356-9021
Practice Address - Street 1:1345 SPACE PARK DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:979-417-4294
Practice Address - Fax:281-356-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty