NPIMap

Organization Active NPI

Mimigrimm,Ma,Individual,Couple&Family Therapy

  • Marriage & Family Therapist
  • Dunedin, FL
National Provider Identifier
1619345519
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MT2514 Issued in FL
Legal business name
MIMIGRIMM,MA,INDIVIDUAL,COUPLE&FAMILY THERAPY
Practice address
860 Cambridge CT
Dunedin, FL 34698-6101
Phone
(727) 504-4126
Fax
(727) 216-3998
NPI assigned
Sep 9, 2015
Last updated
Sep 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mariann Elizabeth Grimm, MANPI 1952473498
Title
Propritor
Phone
(727) 504-4126

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT2514 FL Primary

Addresses

Primary practice location

860 Cambridge CT
Dunedin, FL 34698-6101

Mailing address

1000 Bass Blvd
Dunedin, FL 34698-5801
Phone (727) 504-4126

Other identifiers 1

IdentifierTypeStateIssuer
011891300MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Mimigrimmmaindividualcouplefamily Therapy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1000 Bass Blvd
Dunedin, FL 34698
Phone (727) 504-4126

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1619345519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BASS BLVD",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346985801",
            "telephone_number": "727-504-4126",
            "fax_number": "727-216-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 CAMBRIDGE CT",
            "city": "DUNEDIN",
            "state": "FL",
            "postal_code": "346986101",
            "telephone_number": "727-504-4126",
            "fax_number": "727-216-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMIGRIMM,MA,INDIVIDUAL,COUPLE&FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "MARIANN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PROPRITOR",
        "authorized_official_telephone_number": "727-504-4126",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT2514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011891300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunedin, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.