Provider Demographics
NPI:1386982650
Name:GRIMES, SAMANTHA OROSZ (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:OROSZ
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W BALBOA BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4527
Mailing Address - Country:US
Mailing Address - Phone:949-377-4886
Mailing Address - Fax:
Practice Address - Street 1:1601 W BALBOA BLVD APT D
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4527
Practice Address - Country:US
Practice Address - Phone:949-377-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program