| Banner Clinical & Performance Psychology Llc | |
|
2703 N Mission Rd Peoria IL 61604-2343 | |
| (618) 554-2664 | |
| Not Available |
| Full Name | Banner Clinical & Performance Psychology Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 2703 N Mission Rd, Peoria, Illinois |
| Authorized Official Name and Position | Jeffrey Laurence Grimes (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6185542664 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banner Clinical & Performance Psychology Llc 2703 N Mission Rd Peoria IL 61604-2343 Ph: (618) 554-2664 | Banner Clinical & Performance Psychology Llc 2703 N Mission Rd Peoria IL 61604-2343 Ph: (618) 554-2664 |
| NPI Number | 1578409132 |
|---|---|
| Provider Enumeration Date | 04/27/2026 |
| Last Update Date | 04/27/2026 |
| Certification Date | 04/27/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578409132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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