MEDICARE: MS. ALICE MORGAN SIMMONDS 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	38642	CA

General Provider Information

NPI Number	:	1629304100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE MORGAN SIMMONDS MFT

Provider Business Mailing Address
First Line	:	150 MILLER AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2758
Country	:	US
Telephone Number	:	415-389-9428
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 4TH ST
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3233
Country	:	US
Telephone Number	:	415-389-9428
Fax Number	:

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

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	10/19/2009

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