Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH12537 | FL |
NPI | 1003229428 |
---|---|
Provider Name | Tijuan Grimes |
First Address | Safety Harbor, FL 34695-5205 |
Second Address | Safety Harbor, FL 34695-5205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |