Healthcare Provider Details

I. General information

NPI: 1912821224
Provider Name (Legal Business Name): AUDREY GRIMES APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 CALIFORNIA ST APT 100
SAN FRANCISCO CA
94115-2859
US

IV. Provider business mailing address

2211 CALIFORNIA ST APT 100
SAN FRANCISCO CA
94115-2859
US

V. Phone/Fax

Practice location:
  • Phone: 432-349-4336
  • Fax:
Mailing address:
  • Phone: 432-349-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23273
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number23273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: