Healthcare Provider Details

I. General information

NPI: 1790888659
Provider Name (Legal Business Name): JANET M SIMS JANET SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET M SIMS PH.D.

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 NW JOHNSON ST SUITE 103
PORTLAND OR
97209-1325
US

IV. Provider business mailing address

1920 NW JOHNSON ST SUITE 103
PORTLAND OR
97209-1325
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-5499
  • Fax: 503-719-5499
Mailing address:
  • Phone: 503-719-5499
  • Fax: 503-719-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1978
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number1978
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1978
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: