Individual
DR. KIM MARIE GRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSUDC, CAADC, CRS
Contact information
Practice address
2512 GOLDEN SANDS DR, LAS VEGAS, NV 89128-6801
(215) 919-1558
(215) 491-1750
Mailing address
2512 GOLDEN SANDS DR, LAS VEGAS, NV 89128-6801
(215) 919-1558
(215) 491-1750
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13939693
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0284366000
INDEPENDENCE BLUE CROSS
PA
05
—
07802520
—
PA
01
—
1015164
KEYSTONE MERCY
PA
05
—
1649271933
—
UT
01
—
447982
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/09/2005
Last updated
01/24/2025
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