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General NPI Number Information
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NPI Number | 1093978744
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Entity Type | Individual
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Provider Name | EIRIN C. GRIMES MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 504 S 4TH ST
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City | LARAMIE
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State | WY
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Zip | 82070-3704
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Country | US
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Telephone | 307-755-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2636 PLAINS ST
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City | LARAMIE
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State | WY
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Zip | 82072-5230
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Country | US
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Telephone | 307-399-0993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PPC-419
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-1233
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License Number State | WY
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