Provider Demographics
NPI:1598086233
Name:SIMMS, JOSEPH JORDAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JORDAN
Last Name:SIMMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 BEAR VALLEY RD
Mailing Address - Street 2:PMB #365
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8311
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:
Practice Address - Street 1:24900 HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-5558
Practice Address - Country:US
Practice Address - Phone:661-822-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11554103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist