Provider Demographics
NPI:1922303445
Name:GRIMES, JANA MARIE (LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MARIE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LMHC, CDP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MARIE
Other - Last Name:MATHEWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 NW MAPLE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8127
Mailing Address - Country:US
Mailing Address - Phone:253-686-3683
Mailing Address - Fax:
Practice Address - Street 1:1740 NW MAPLE ST STE 210
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8127
Practice Address - Country:US
Practice Address - Phone:253-686-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60131241101Y00000X
WACO60146808101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor