Healthcare Provider Details

I. General information

NPI: 1225083330
Provider Name (Legal Business Name): PAUL L SYMMONDS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 VISTA DEL LAGO DR
VALLEY SPRINGS CA
95252-9294
US

IV. Provider business mailing address

PO BOX 1319
SALIDA CA
95368-1319
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-9538
  • Fax:
Mailing address:
  • Phone: 209-543-6279
  • Fax: 209-543-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 22487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: