Provider Demographics
NPI:1194961243
Name:SIMMONS JANSEN, SHAKIRA MARINI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAKIRA
Middle Name:MARINI
Last Name:SIMMONS JANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16111 PLUMMER ST BLDG 10
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-891-7711
Mailing Address - Fax:
Practice Address - Street 1:16111 PLUMMER ST BLDG 10
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3960103TC0700X
CA30754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical