Provider Demographics
NPI:1740481423
Name:SIMMONS, MICHAEL LEE (LCSW, CDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:SIMMONS
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Gender:M
Credentials:LCSW, CDS
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Mailing Address - Street 1:10630 LAKESIDE DR N
Mailing Address - Street 2:UNIT J
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5078
Mailing Address - Country:US
Mailing Address - Phone:562-252-5051
Mailing Address - Fax:714-508-7301
Practice Address - Street 1:17632 IRVINE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3148
Practice Address - Country:US
Practice Address - Phone:714-745-7198
Practice Address - Fax:714-508-7301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2009-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CALCS236721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical