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General NPI Number Information
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NPI Number | 1194961243
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Entity Type | Individual
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Provider Name | SHAKIRA MARINI SIMMONS JANSEN PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 5901 E 7TH ST VISN 22 TELEMENTAL HEALTH
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City | LONG BEACH
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State | CA
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Zip | 90822
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Country | US
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Telephone | 562-625-9357
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Fax | 267-908-6605
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Provider Business Mailing Address
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Address Line | 5825 LINCOLN AVE STE D440
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City | BUENA PARK
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State | CA
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Zip | 90620-3463
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Country | US
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Telephone | 714-699-4465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 30754
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3960
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License Number State | AZ
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