Provider Demographics
NPI:1932734357
Name:GRIMALDI, ELIZABETH JODI (LLMFT, MDIV)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JODI
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:LLMFT, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 N TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7887
Mailing Address - Country:US
Mailing Address - Phone:989-948-3503
Mailing Address - Fax:616-327-6333
Practice Address - Street 1:233 FULTON ST E STE 28
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3262
Practice Address - Country:US
Practice Address - Phone:616-228-9244
Practice Address - Fax:616-327-6333
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006921101YM0800X
106H00000X
MI4101007262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health