NPIMap

Organization Active NPI

Mimigrimm Ma Individual, Couple, & Family Therapy

  • Clinic/Center
  • Safety Harbor, FL
National Provider Identifier
1649661984
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2514MT Issued in FL
Legal business name
MIMIGRIMM MA INDIVIDUAL, COUPLE, & FAMILY THERAPY
Practice address
685 Main St
Suite C
Safety Harbor, FL 34695-3562
Phone
(727) 504-4126
Fax
(727) 216-3998
NPI assigned
Feb 9, 2015
Last updated
Feb 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 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
Marriage and Family Therapist
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
Clinic/Center 261Q00000X 2514MT FL Primary

Addresses

Primary practice location

685 Main St
Suite C
Safety Harbor, FL 34695-3562

Mailing address

860 Cambridge CT
Dunedin, FL 34698-6101
Phone (727) 504-4126

Other identifiers 1

IdentifierTypeStateIssuer
779438MedicaidFL

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.

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": "1423440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1649661984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 MAIN ST",
            "address_2": "SUITE C",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346953562",
            "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": "2015-02-09",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "MARIANN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "MARRIAGE AND FAMILY THERAPIST",
        "authorized_official_telephone_number": "727-504-4126",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "2514MT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "779438",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Safety Harbor, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.