Provider Demographics
NPI:1932373016
Name:GRIMES HEALTHCARE, INC.
Entity Type:Organization
Organization Name:GRIMES HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RN
Authorized Official - Phone:214-502-6942
Mailing Address - Street 1:1510 N HAMPTON RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8300
Mailing Address - Country:US
Mailing Address - Phone:214-502-6942
Mailing Address - Fax:214-351-2884
Practice Address - Street 1:1510 N HAMPTON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8300
Practice Address - Country:US
Practice Address - Phone:214-502-6942
Practice Address - Fax:214-351-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty