Provider Demographics
NPI:1700976164
Name:GRIMSLEY, CHARLES WAYNE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WAYNE
Last Name:GRIMSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 HWY 65
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:CO
Mailing Address - Zip Code:81643
Mailing Address - Country:US
Mailing Address - Phone:970-268-5008
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6428
Practice Address - Country:US
Practice Address - Phone:970-263-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral