Healthcare Provider Details

I. General information

NPI: 1245304617
Provider Name (Legal Business Name): CLINTON E. SIMS PSY. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E HIGHWAY 50 STE 6
CLERMONT FL
34711-2581
US

IV. Provider business mailing address

17631 LONG RIDGE DR
MONTVERDE FL
34756-4011
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-9733
  • Fax:
Mailing address:
  • Phone: 407-469-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: