Healthcare Provider Details

I. General information

NPI: 1427459478
Provider Name (Legal Business Name): LORI SIMS LPCC 8663
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR STE D
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR STE D
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-765-6754
  • Fax: 209-567-4224
Mailing address:
  • Phone: 209-765-6754
  • Fax: 209-558-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC8663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: