Provider Demographics
NPI:1215063946
Name:GRIMMITT, MONA L
Entity type:Individual
Prefix:MISS
First Name:MONA
Middle Name:L
Last Name:GRIMMITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11041 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2516
Mailing Address - Country:US
Mailing Address - Phone:626-442-4177
Mailing Address - Fax:626-442-4498
Practice Address - Street 1:11041 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2516
Practice Address - Country:US
Practice Address - Phone:626-442-4177
Practice Address - Fax:626-442-4498
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)