Provider Demographics
NPI:1790737120
Name:SIMONS, JONATHAN RICHARD (PSYD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RICHARD
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 MEDICAL CENTER DRIVE,
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1938
Mailing Address - Country:US
Mailing Address - Phone:818-981-2050
Mailing Address - Fax:818-981-2382
Practice Address - Street 1:20501 VENTURA BLVD.,
Practice Address - Street 2:SUITE 324
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-6425
Practice Address - Country:US
Practice Address - Phone:818-887-1926
Practice Address - Fax:818-887-1927
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32596103T00000X
CAMFC32596106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist