MEDICARE: MRS. CHRISTY GRIMES MSW, LCSW

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	1041C0700X	Clinical Social Worker	2006000250	MO

General Provider Information

NPI Number	:	1235215278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTY GRIMES MSW, LCSW

Provider Business Mailing Address
First Line	:	20509 S STATE RT J
Second Line	:	PO BOX 447
City	:	PECULIAR
State	:	MO
Zip	:	64078-0447
Country	:	US
Telephone Number	:	816-779-5173
Fax Number	:	816-758-5112

Provider Business Practice Location Address
First Line	:	20509 SOUTH STATE ROUTE J
Second Line	:
City	:	PECULIAR
State	:	MO
Zip	:	64078-0447
Country	:	US
Telephone Number	:	816-779-5173
Fax Number	:	816-758-5112

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/09/2007

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