Provider Demographics
NPI:1508945098
Name:SIMS, CLARENCE LEON (EDD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LEON
Last Name:SIMS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8958
Mailing Address - Country:US
Mailing Address - Phone:210-559-1779
Mailing Address - Fax:830-249-9174
Practice Address - Street 1:216 MARKET AVE STE 150
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3003
Practice Address - Country:US
Practice Address - Phone:210-559-1779
Practice Address - Fax:830-249-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6332101YP2500X
TX1980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist