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Individual
TANNER GRIMSLEY
Active
Individual
TANNER GRIMSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1692
ND
101YP2500X
Professional Counselor
850-10-1-15A
ND
Other
Enumeration date
11/15/2012
Last updated
01/24/2017
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