Provider Demographics
NPI:1811601636
Name:SIMONS, JESSICA T (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:SIMONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 S WOODROW LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-3646
Mailing Address - Country:US
Mailing Address - Phone:435-200-3102
Mailing Address - Fax:
Practice Address - Street 1:2926 S WOODROW LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-3646
Practice Address - Country:US
Practice Address - Phone:435-200-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13188885-3902106H00000X, 106H00000X
TX204937106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist