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General NPI Number Information
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NPI Number | 1306298179
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Entity Type | Individual
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Provider Name | EBONEE ALYSSA SIMMONS MFT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 1664 BROADWAY
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City | EL CAJON
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State | CA
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Zip | 92021-5201
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Country | US
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Telephone | 619-579-8685
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Fax |
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Provider Business Mailing Address
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Address Line | 1664 BROADWAY
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City | EL CAJON
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State | CA
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Zip | 92021-5201
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 124505
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 142972
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 156039
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License Number State | CA
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