MEDICARE: SIMSON, WYNN AND WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1003165580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMSON, WYNN AND WILLIAMS

Provider Business Mailing Address
First Line	:	7844 MADISON AVE
Second Line	:	SUITE 106
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3519
Country	:	US
Telephone Number	:	916-476-6301
Fax Number	:

Provider Business Practice Location Address
First Line	:	7844 MADISON AVE
Second Line	:	SUITE 106
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-3519
Country	:	US
Telephone Number	:	916-476-6301
Fax Number	:

Authorized Official
Title or Position	:	PARTNER/COUNSELOR
Name	:	DR. SALLY WYNN
Credential	:	DR.AD, MCA, MRAS
Telephone Number	:	916-476-6301

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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