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General NPI Number Information
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NPI Number | 1669556023
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Entity Type | Individual
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Provider Name | ROBERT JHAN SIMMONS LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 10116 116TH ST E SUITE 204-B
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City | PUYALLUP
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State | WA
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Zip | 98373-3543
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Country | US
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Telephone | 253-237-4188
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Fax | 253-604-4533
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Provider Business Mailing Address
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Address Line | 10116 116TH ST E SUITE 204-B
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City | PUYALLUP
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State | WA
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Zip | 98373-3543
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Country | US
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Telephone | 253-237-4188
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Fax | 253-604-4533
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 42611
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00011144
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00002650
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License Number State | WA
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