Healthcare Provider Details

I. General information

NPI: 1356423701
Provider Name (Legal Business Name): JOHN JOSEPH GRIMAUD MA LPC LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13354 MANCHESTER RD SUITE 220
SAINT LOUIS MO
63131-1709
US

IV. Provider business mailing address

13354 MANCHESTER RD SUITE 220
SAINT LOUIS MO
63131-1709
US

V. Phone/Fax

Practice location:
  • Phone: 314-220-6981
  • Fax: 314-692-7929
Mailing address:
  • Phone: 314-220-6981
  • Fax: 314-692-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCS000987
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: