Provider Demographics
NPI:1174906051
Name:GRIMSLEY, BRIAN (NHA, MSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:GRIMSLEY
Suffix:
Gender:M
Credentials:NHA, MSW
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:GRIMSLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NHA, MSW
Mailing Address - Street 1:1725 GRANDE POINTE BLVD APT 23109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-5482
Mailing Address - Country:US
Mailing Address - Phone:407-731-6246
Mailing Address - Fax:
Practice Address - Street 1:1725 GRANDE POINTE BLVD APT 23109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-5482
Practice Address - Country:US
Practice Address - Phone:407-731-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNH5665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health