Organization
MIMIGRIMM,MA,INDIVIDUAL,COUPLE&FAMILY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANN ELIZABETH GRIMM MA (PROPRITOR)
(727) 504-4126
Entity
Organization
Contact information
Practice address
860 CAMBRIDGE CT, DUNEDIN, FL 34698-6101
(727) 504-4126
(727) 216-3998
Mailing address
1000 BASS BLVD, DUNEDIN, FL 34698-5801
(727) 504-4126
(727) 216-3998
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MT2514
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011891300
—
FL
Enumeration date
09/09/2015
Last updated
09/09/2015
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