Provider Demographics
NPI:1821311234
Name:SIMMONS, JOHN JACOB (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JACOB
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:442 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5006
Mailing Address - Country:US
Mailing Address - Phone:310-570-9368
Mailing Address - Fax:
Practice Address - Street 1:442 W ESPLANADE AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5006
Practice Address - Country:US
Practice Address - Phone:310-570-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist