Provider Demographics
NPI:1235963760
Name:GRIMM, MATTHEW DAVID (MA, MS, NCC, LAPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:GRIMM
Suffix:
Gender:M
Credentials:MA, MS, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 W CHESTNUT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4661
Mailing Address - Country:US
Mailing Address - Phone:724-255-6940
Mailing Address - Fax:
Practice Address - Street 1:378 W CHESTNUT ST STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4661
Practice Address - Country:US
Practice Address - Phone:724-255-6940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health