Provider Demographics
NPI:1205825072
Name:SIMONIS, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:SIMONIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5070 N 40TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2148
Mailing Address - Country:US
Mailing Address - Phone:480-905-8755
Mailing Address - Fax:480-905-8851
Practice Address - Street 1:8160 N HAYDEN RD
Practice Address - Street 2:SUITE J112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2467
Practice Address - Country:US
Practice Address - Phone:480-905-8755
Practice Address - Fax:480-905-8851
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ675OtherLICENSE
AZ675OtherLICENSE