=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801240155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANIE GRIMES LPC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2016
-----------------------------------------------------
Last Update Date | 09/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 W HICKORY ST SUITE 213
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-4156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-218-6632
-----------------------------------------------------
Fax | 940-205-5016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1916 KINGS CT
-----------------------------------------------------
City | FLOWER MOUND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75028-1067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-453-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 13732
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------