Healthcare Provider Details

I. General information

NPI: 1669556023
Provider Name (Legal Business Name): ROBERT JHAN SIMMONS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOB SIMMONS LMFT

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10116 116TH ST E SUITE 204-B
PUYALLUP WA
98373-3543
US

IV. Provider business mailing address

10116 116TH ST E SUITE 204-B
PUYALLUP WA
98373-3543
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-4188
  • Fax: 253-604-4533
Mailing address:
  • Phone: 253-237-4188
  • Fax: 253-604-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00011144
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 42611
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00002650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: