Provider Demographics
NPI:1790836542
Name:SIMMONS, ADRIAN JINKICHI (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:JINKICHI
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5131
Mailing Address - Country:US
Mailing Address - Phone:760-508-1075
Mailing Address - Fax:
Practice Address - Street 1:15409 ANACAPA RD STE F
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2463
Practice Address - Country:US
Practice Address - Phone:760-508-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA116635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health