Provider Demographics
NPI:1356423701
Name:GRIMAUD, JOHN JOSEPH (MA LPC LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:GRIMAUD
Suffix:
Gender:M
Credentials:MA LPC LCSW
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Other - First Name:
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Mailing Address - Street 1:13354 MANCHESTER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1709
Mailing Address - Country:US
Mailing Address - Phone:314-220-6981
Mailing Address - Fax:314-692-7929
Practice Address - Street 1:13354 MANCHESTER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1709
Practice Address - Country:US
Practice Address - Phone:314-220-6981
Practice Address - Fax:314-692-7929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOCS000987101YP2500X
MOSW0042121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
170538OtherVALUEOPTIONS
18794OtherBLUE CROSS BLUE SHIELD
6214089OtherUNITED HEALTHCARE UNITED
143303OtherCMR
38295OtherHEALTHLINK NON PAR
015264OtherEXCLUSIVE CHOICE FMH