Healthcare Provider Details

I. General information

NPI: 1235963760
Provider Name (Legal Business Name): MATTHEW DAVID GRIMM MA, NCC, LPC, ASDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 WASHINGTON RD STE 2
MC MURRAY PA
15317-6400
US

IV. Provider business mailing address

3307 WASHINGTON RD STE 2
MC MURRAY PA
15317-6400
US

V. Phone/Fax

Practice location:
  • Phone: 412-259-3885
  • Fax: 412-643-2648
Mailing address:
  • Phone: 412-259-3885
  • Fax: 412-643-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC021071
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: