Provider Demographics
NPI:1023555323
Name:SIMPSON, JERMAINE RASHAD (LMFT)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:RASHAD
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 ALTADENA AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3352
Mailing Address - Country:US
Mailing Address - Phone:619-829-3742
Mailing Address - Fax:
Practice Address - Street 1:4568 ALTADENA AVE
Practice Address - Street 2:APT. B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3352
Practice Address - Country:US
Practice Address - Phone:619-829-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist