MEDICARE: MR. CHRISTOPHER GRIMES 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	51679	TX

General Provider Information

NPI Number	:	1982080800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER GRIMES LCSW

Provider Business Mailing Address
First Line	:	2211 NORFOLK ST STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4044
Country	:	US
Telephone Number	:	713-540-2838
Fax Number	:	713-526-0212

Provider Business Practice Location Address
First Line	:	2211 NORFOLK ST STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4044
Country	:	US
Telephone Number	:	713-540-2838
Fax Number	:	713-526-0212

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

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	06/02/2016

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