Provider Demographics
NPI:1295071843
Name:GRIMES, GEORGIA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:
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 1:14635 S HARRELLS FERRY RD
Mailing Address - Street 2:STE. 3-A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2959
Mailing Address - Country:US
Mailing Address - Phone:225-751-5412
Mailing Address - Fax:225-751-5847
Practice Address - Street 1:14635 S HARRELLS FERRY RD
Practice Address - Street 2:STE. 3-A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2959
Practice Address - Country:US
Practice Address - Phone:225-751-5412
Practice Address - Fax:225-751-5847
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1164101YA0400X
LA831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)