Basic Information
| Provider Information | |||||||||
| NPI: | 1093978744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIMES | ||||||||
| FirstName: | EIRIN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2636 PLAINS ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820725230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073990993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 504 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820703704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077551000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 02/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | PPC-419 | WY | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | LPC-1233 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.