Provider Demographics
NPI:1427353150
Name:JANET M GRIM MA LMFT
Entity type:Organization
Organization Name:JANET M GRIM MA LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MCCULLOUGH
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:904-269-7500
Mailing Address - Street 1:1726 KINGSLEY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-269-7500
Mailing Address - Fax:904-269-9972
Practice Address - Street 1:1726 KINGSLEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-269-7500
Practice Address - Fax:904-269-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty