Healthcare Provider Details

I. General information

NPI: 1023580263
Provider Name (Legal Business Name): JAMES W SIMMONS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73345 HIGHWAY 111 STE 203
PALM DESERT CA
92260-3909
US

IV. Provider business mailing address

291 E MEL AVE UNIT 370
PALM SPRINGS CA
92262-4848
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-3158
  • Fax:
Mailing address:
  • Phone: 213-804-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: