Provider Demographics
NPI:1932325339
Name:SIMINOSKI, TED (MFT)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:
Last Name:SIMINOSKI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 PLACERVILLE DR
Mailing Address - Street 2:STE 17
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3920
Mailing Address - Country:US
Mailing Address - Phone:530-621-5114
Mailing Address - Fax:530-295-2521
Practice Address - Street 1:2802 MALLARD LN
Practice Address - Street 2:STE. C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-621-5114
Practice Address - Fax:530-295-2521
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 23200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist