Healthcare Provider Details

I. General information

NPI: 1114067618
Provider Name (Legal Business Name): GREGORY M SIMS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. GREGORY KNOX SIMS

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18025 BLATTNER ROAD
PHILO CA
95466
US

IV. Provider business mailing address

PO BOX 1
BOONVILLE CA
95415
US

V. Phone/Fax

Practice location:
  • Phone: 707-895-2304
  • Fax: 707-895-2537
Mailing address:
  • Phone: 707-895-2304
  • Fax: 707-895-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberCA LIC NO PSY4045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4045
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY4045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: