Healthcare Provider Details

I. General information

NPI: 1407767692
Provider Name (Legal Business Name): TAMIKO SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMIKO SIMMONS PPS

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E CALIFORNIA AVE
FRESNO CA
93706-3736
US

IV. Provider business mailing address

540 E CALIFORNIA AVE
FRESNO CA
93706-3736
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-2670
  • Fax:
Mailing address:
  • Phone: 559-457-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240222924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: