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Individual

LISA R GRIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PLPC

Contact information

Practice address
800 E WALNUT ST, SPRINGFIELD, MO 65806-2424
(417) 402-8350
Mailing address
723 N OAK GROVE AVE, SPRINGFIELD, MO 65802-2367
(417) 231-5723

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
225700000X
Massage Therapist
20068964
MO

Other

Enumeration date
05/16/2019
Last updated
05/29/2024
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