Provider Demographics
NPI:1912925900
Name:SIMMS, MARY M (MFT, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:SIMMS
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:FAMILY OUTREACH
Other - Middle Name:COUNSELING
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4401 ATLANTIC AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2218
Mailing Address - Country:US
Mailing Address - Phone:562-984-2012
Mailing Address - Fax:562-984-2022
Practice Address - Street 1:4401 ATLANTIC AVE STE 231
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-984-2012
Practice Address - Fax:562-984-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 28731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional