Provider Demographics
NPI:1578145686
Name:SIMONS, ALYSON VISLOCKY
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:VISLOCKY
Last Name:SIMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S SHATTUCK PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2204
Mailing Address - Country:US
Mailing Address - Phone:805-689-5658
Mailing Address - Fax:
Practice Address - Street 1:11838 BERNARDO PLAZA CT STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2434
Practice Address - Country:US
Practice Address - Phone:858-380-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW99570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health