Doctor Name: | TIJUAN GRIMES |
NPI Number: | 1003229428 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LMHC |
License Number: | MH12537 |
Business Practice Address: | 3180 Enterprise Rd E Safety Harbor, FL - 346955205 |
Business Phone Number: | 7277254761 |
Business Fax Number: | |
Mailing Address: | 3180 Enterprise Rd E, SAFETY HARBOR |
State: | FL |
Postal Code: | 346955205 |
Phone Number: | 7277254761 |
Fax Number: | |
NPI Enumeration Date: | 06/03/2014 |
NPI Last Update Date: | 06/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH12537 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |