Doctor Name: | MR. PAUL GRIM |
NPI Number: | 1356645576 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS |
License Number: | LH60195290 |
Business Practice Address: | 70 North Estes White Salmon, WA - 98672 |
Business Phone Number: | 5094932080 |
Business Fax Number: | |
Mailing Address: | 781 Centerville Hwy, LYLE |
State: | WA |
Postal Code: | 986359455 |
Phone Number: | 5094932080 |
Fax Number: | |
NPI Enumeration Date: | 01/03/2011 |
NPI Last Update Date: | 01/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60195290 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |