Provider Demographics
NPI:1194138495
Name:SIMMONS, JOHNNY JR (LMFT)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:SIMMONS
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 N WINERY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4812
Mailing Address - Country:US
Mailing Address - Phone:323-573-2171
Mailing Address - Fax:
Practice Address - Street 1:2190 N WINERY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4812
Practice Address - Country:US
Practice Address - Phone:323-642-6703
Practice Address - Fax:559-558-8999
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108461106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist