Organization Name: | JONATHAN ALAN SIMONS PHD PC |
NPI Number: | 1104048925 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATRICIA CLAIRE STELLING (VICE PRESIDENT-OFFICE MANAGER) |
Mailing Address: | 1506 Azalea Dr Ste 602 Surfside Beach |
State: | SC US |
Postal Code: | 295755232 |
Phone Number: | 8438280502 |
Fax Number: | 8438284402 |
NPI Enumeration Date: | 05/02/2007 |
NPI Last Update Date: | 08/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 639 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |