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General NPI Number Information
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NPI Number | 1861501405
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Entity Type | Individual
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Provider Name | DONALD W. GRIMM CP
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 490 S FARRELL DR STE C207
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7944
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Country | US
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Telephone | 760-699-6363
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Fax | 951-769-6753
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Provider Business Mailing Address
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Address Line | 773 PINE RIDGE CIR
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City | BEAUMONT
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State | CA
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Zip | 92223-7153
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Country | US
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Telephone | 951-769-3288
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Fax | 951-769-3288
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-20305
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License Number State | CA
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