Provider Demographics
NPI:1720523111
Name:GRIMES, CHRYSTAL
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 COMMERCIAL ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1036
Mailing Address - Country:US
Mailing Address - Phone:503-983-9900
Mailing Address - Fax:503-983-9909
Practice Address - Street 1:1011 COMMERCIAL ST NE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1036
Practice Address - Country:US
Practice Address - Phone:503-983-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health