Individual
SUSAN GRIMES FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
214 MAIN ST, BAXTER, TN 38544-5280
(931) 588-0475
Mailing address
214 DYER GRIMES RD, COOKEVILLE, TN 38501-4399
(931) 783-1113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5175
TN
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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