Provider Demographics
NPI:1841394293
Name:SCHNEIDER, GINA SIMMONS (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:SIMMONS
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD MFT
Mailing Address - Street 1:16935 W BERNARDO DR STE 236
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1637
Mailing Address - Country:US
Mailing Address - Phone:858-538-5587
Mailing Address - Fax:
Practice Address - Street 1:16935 W BERNARDO DR STE 236
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1637
Practice Address - Country:US
Practice Address - Phone:858-538-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28866ZOtherBLUE SHIELD PROVIDER ID