Provider Demographics
NPI:1700154135
Name:GRIMES, MISTY LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6474 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1455
Mailing Address - Country:US
Mailing Address - Phone:720-990-0086
Mailing Address - Fax:
Practice Address - Street 1:6474 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1455
Practice Address - Country:US
Practice Address - Phone:720-990-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099239621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical