Provider Demographics
NPI:1013666866
Name:GRIMSLEY, KIMBERLY VANDERMARK
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:VANDERMARK
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST PHD
Mailing Address - Street 1:1501 N AMBURN RD STE 12
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2466
Mailing Address - Country:US
Mailing Address - Phone:409-797-4174
Mailing Address - Fax:409-655-5238
Practice Address - Street 1:1501 N AMBURN RD STE 12
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2466
Practice Address - Country:US
Practice Address - Phone:409-797-4174
Practice Address - Fax:409-655-5238
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X, 103TH0100X, 103TC2200X, 103TM1800X, 103TF0200X, 103TH0004X, 103TP0814X, 103TR0400X
TX39052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation