Provider Demographics
NPI:1104107499
Name:GRIMSLEY, CARLA ANETA (BA)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANETA
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:NETA
Other - Middle Name:
Other - Last Name:GRIMSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:370 W COMMUNITY CHAPPELL RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525
Mailing Address - Country:US
Mailing Address - Phone:580-364-3026
Mailing Address - Fax:
Practice Address - Street 1:370 W COMMUNITY CHAPPELL RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525
Practice Address - Country:US
Practice Address - Phone:580-364-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor