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General NPI Number Information
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NPI Number | 1104265982
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Entity Type | Organization
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Legal Business Name | MARK S. GRIMM, LCSW LLC
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 355 ALBION ST
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City | DENVER
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State | CO
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Zip | 80220-4912
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Country | US
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Telephone | 720-841-1742
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Fax |
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Provider Business Mailing Address
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Address Line | 355 ALBION ST
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City | DENVER
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State | CO
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Zip | 80220-4912
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Country | US
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Telephone | 720-841-1742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARK S. GRIMM
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Credential | LCSW
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Telephone | 720-841-1742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 985017
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License Number State | CO
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