Provider Demographics
NPI:1164585444
Name:SIMMONS, HALSEY NEWBROUGH (MFT)
Entity Type:Individual
Prefix:
First Name:HALSEY
Middle Name:NEWBROUGH
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAYHEW WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4398
Mailing Address - Country:US
Mailing Address - Phone:707-315-8889
Mailing Address - Fax:888-488-6656
Practice Address - Street 1:140 MAYHEW WAY STE 300
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4398
Practice Address - Country:US
Practice Address - Phone:707-315-8889
Practice Address - Fax:888-488-6656
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30120OtherLICENSE NUMBER