MEDICARE: YANCEY W GRIMES LPC-INTERN

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	101YP2500X	Professional Counselor	81281	TX

General Provider Information

NPI Number	:	1558823682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANCEY W GRIMES LPC-INTERN

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	800-994-0371
Fax Number	:	254-215-9722

Provider Business Practice Location Address
First Line	:	5701 AIRPORT RD STE L103
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-7092
Country	:	US
Telephone Number	:	254-724-2585
Fax Number	:	254-724-1747

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

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	11/11/2025

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