Provider Demographics
NPI:1942649595
Name:SIMPSON, SHELLY MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:MARIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 S SHENANDOAH ST APT 1/2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3578
Mailing Address - Country:US
Mailing Address - Phone:281-703-9065
Mailing Address - Fax:
Practice Address - Street 1:1477 S SHENANDOAH ST APT 1/2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3578
Practice Address - Country:US
Practice Address - Phone:281-703-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker