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General NPI Number Information
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NPI Number | 1366829632
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Entity Type | Organization
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Legal Business Name | DEBBIE SIMMS-KEENEY MFT
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 8336 BRENTWOOD BLVD
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City | BRENTWOOD
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State | CA
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Zip | 94513-1113
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Country | US
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Telephone | 415-710-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 8336 BRENTWOOD BLVD
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City | BRENTWOOD
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State | CA
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Zip | 94509
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Country | US
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Telephone | 415-710-2126
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Fax |
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Authorized Official
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Title or Position | MARRIAGE FAMILY THERAPIST INTERN
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Name | MRS. PONEVA HAMLIN
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Credential | MA
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Telephone | 415-710-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | A6412408
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License Number State | CA
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