Provider Demographics
NPI:1851662068
Name:SIMKINS SLUK, PETER DAMIAN (MA, IMFT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DAMIAN
Last Name:SIMKINS SLUK
Suffix:
Gender:M
Credentials:MA, IMFT
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:DAMIAN
Other - Last Name:SLUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFTA, MHP
Mailing Address - Street 1:3256 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3416
Mailing Address - Country:US
Mailing Address - Phone:216-577-3333
Mailing Address - Fax:
Practice Address - Street 1:3256 ORMOND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3416
Practice Address - Country:US
Practice Address - Phone:216-577-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.1800046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist