Provider Demographics
NPI:1801943436
Name:SIMMONS, JOANN RUTH (MFT)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:RUTH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:RUTH
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:10068 COPPER MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6830
Mailing Address - Country:US
Mailing Address - Phone:951-204-7124
Mailing Address - Fax:909-912-8252
Practice Address - Street 1:10630 TOWN CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6805
Practice Address - Country:US
Practice Address - Phone:951-204-7124
Practice Address - Fax:909-912-8252
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28102OtherLICENSE NUMBER