Provider Demographics
NPI:1699703645
Name:GRIMES, GEORGE PERRY (PHD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PERRY
Last Name:GRIMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MARINERS DR
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2261
Mailing Address - Country:US
Mailing Address - Phone:979-417-4294
Mailing Address - Fax:281-538-8069
Practice Address - Street 1:480 MARINERS DR
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2261
Practice Address - Country:US
Practice Address - Phone:979-417-4294
Practice Address - Fax:281-538-8069
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025614102Medicaid
TX025614103Medicaid
TX87127AOtherBLUE CROSS BLUE SHIELD
TX8G0705Medicare ID - Type Unspecified
TX025614102Medicaid
TX8F2366Medicare PIN