Individual
MR. GARY S GRIMM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC
Contact information
Practice address
7628A OLD SANTA FE TRL, SANTA FE, NM 87505-9359
(505) 986-8688
Mailing address
PO BOX 9006, SANTA FE, NM 87504-9006
(505) 986-8688
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0092
NM
Other
Enumeration date
09/12/2007
Last updated
09/12/2007
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