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General NPI Number Information
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NPI Number | 1982954269
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Entity Type | Organization
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Legal Business Name | SIMSON, WYNN AND WILLIAMS
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 7844 MADISON AVE., SUITE 106
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City | FAIR OAKS
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State | CA
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Zip | 95628
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Country | US
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Telephone | 916-476-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 7844 MADISON AVE., SUITE 106
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City | FAIR OAKS
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State | CA
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Zip | 95628
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Country | US
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Telephone | 916-476-6301
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | SALLY WYNN
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Credential | DRAD
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Telephone | 916-476-6301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | RAS #W0702211501
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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 | MFT28031
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License Number State | CA
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