Provider Demographics
NPI:1154333193
Name:SIMONELIC, BECKY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:A
Last Name:SIMONELIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W MOUNTAIN SKY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85045-0413
Mailing Address - Country:US
Mailing Address - Phone:480-540-2984
Mailing Address - Fax:480-656-0011
Practice Address - Street 1:4425 E AGAVE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0619
Practice Address - Country:US
Practice Address - Phone:480-540-2984
Practice Address - Fax:480-656-0011
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3745103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling