MEDICARE: MR. DAVID MICHAEL SIMMONS MFT

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	106H00000X	Marriage & Family Therapist	MFC25163	CA

General Provider Information

NPI Number	:	1326218470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MICHAEL SIMMONS MFT

Provider Business Mailing Address
First Line	:	1820 SOUTH CATALINA AVENUE
Second Line	:	SUITE 108
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 S CATALINA AVE
Second Line	:	SUITE 108
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5511
Country	:	US
Telephone Number	:	310-832-1874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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