Healthcare Provider Details

I. General information

NPI: 1538031398
Provider Name (Legal Business Name): KAREN GRIMES BAS, R-AAC, CPSST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 BROADWAY ST
LONGVIEW WA
98632-3830
US

IV. Provider business mailing address

PO BOX 2394
LONGVIEW WA
98632-8455
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-5419
  • Fax: 844-612-6673
Mailing address:
  • Phone: 360-200-5419
  • Fax: 844-612-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG70154747
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNC10061390
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPE70077645
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: