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General NPI Number Information
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NPI Number | 1912248139
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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 | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1707 COLE BLVD SUITE 250
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City | GOLDEN
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State | CO
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Zip | 80401-3220
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Country | US
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Telephone | 303-716-8013
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Fax | 303-763-5495
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Provider Business Mailing Address
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Address Line | 1707 COLE BLVD SUITE 250
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City | GOLDEN
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State | CO
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Zip | 80401-3220
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Country | US
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Telephone | 303-716-8013
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Fax | 303-763-5495
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK GRIMM
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Credential | LCSW
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Telephone | 303-716-8013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 985017
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License Number State | CO
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