MEDICARE: JACQUELINE SIM L.M.F.T. ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	202280	TX

General Provider Information

NPI Number	:	1225448491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SIM L.M.F.T. ASSOCIATE

Provider Business Mailing Address
First Line	:	4331 BRIGHTWOOD DR
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77068-1700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4331 BRIGHTWOOD DR STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-1700
Country	:	US
Telephone Number	:	281-772-2689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	04/12/2016

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