Provider Demographics
NPI:1447541024
Name:GRIM, JENNIFER ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:GRIM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:AR
Mailing Address - Zip Code:72749-0020
Mailing Address - Country:US
Mailing Address - Phone:918-696-5214
Mailing Address - Fax:888-844-1669
Practice Address - Street 1:20856 BOYS HOME RD.
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:AR
Practice Address - Zip Code:72749
Practice Address - Country:US
Practice Address - Phone:918-696-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1507079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional