Provider Demographics
NPI:1952848079
Name:SIMMONS, EVAN (LMFT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:
Other - Last Name:FARRELL SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5655 LINDERO CANYON RD STE 326
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4051
Mailing Address - Country:US
Mailing Address - Phone:424-234-3431
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD STE 326
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4051
Practice Address - Country:US
Practice Address - Phone:424-234-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist