MEDICARE: ALEXANDRIA GRIM LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2498	MN

General Provider Information

NPI Number	:	1225562333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA GRIM LPCC

Provider Business Mailing Address
First Line	:	121 83RD AVE NE APT 108
Second Line	:
City	:	FRIDLEY
State	:	MN
Zip	:	55432-1881
Country	:	US
Telephone Number	:	314-295-9103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 113
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	314-295-9103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	05/25/2020

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