Provider Demographics
NPI:1669556023
Name:SIMMONS, ROBERT JHAN (LMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JHAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:10116 116TH ST E
Mailing Address - Street 2:SUITE 204-B
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3543
Mailing Address - Country:US
Mailing Address - Phone:253-237-4188
Mailing Address - Fax:253-604-4533
Practice Address - Street 1:10116 116TH ST E
Practice Address - Street 2:SUITE 204-B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3543
Practice Address - Country:US
Practice Address - Phone:253-237-4188
Practice Address - Fax:253-604-4533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42611106H00000X
WALH00011144101YM0800X
WALF00002650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist