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General NPI Number Information
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NPI Number | 1205825072
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Entity Type | Individual
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Provider Name | JOHN MICHAEL SIMONIS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8160 N HAYDEN RD SUITE J112
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-2467
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Country | US
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Telephone | 480-905-8755
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Fax | 480-905-8851
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Provider Business Mailing Address
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Address Line | 5070 N 40TH ST SUITE 220
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City | PHOENIX
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State | AZ
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Zip | 85018-2148
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Country | US
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Telephone | 480-905-8755
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Fax | 480-905-8851
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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 | 675
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License Number State | AZ
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