Healthcare Provider Details

I. General information

NPI: 1205825072
Provider Name (Legal Business Name): JOHN MICHAEL SIMONIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 N HAYDEN RD SUITE J112
SCOTTSDALE AZ
85258-2467
US

IV. Provider business mailing address

5070 N 40TH ST SUITE 220
PHOENIX AZ
85018-2148
US

V. Phone/Fax

Practice location:
  • Phone: 480-905-8755
  • Fax: 480-905-8851
Mailing address:
  • Phone: 480-905-8755
  • Fax: 480-905-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number675
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: