Provider Demographics
NPI:1336212240
Name:SIMS, JERRILYN MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:JERRILYN
Middle Name:MARIE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:JERRILYN
Other - Middle Name:MARIE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 WATT AVE
Mailing Address - Street 2:STE 190
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821
Mailing Address - Country:US
Mailing Address - Phone:916-483-8673
Mailing Address - Fax:916-944-3344
Practice Address - Street 1:3550 WATT AVE
Practice Address - Street 2:STE 190
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-483-8673
Practice Address - Fax:916-944-3344
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist