Provider Demographics
NPI:1326782756
Name:SIMONINI, CARLOS GUSTAVO (LMFT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:GUSTAVO
Last Name:SIMONINI
Suffix:
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 1:13439 BROADWAY EXT # 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2256
Mailing Address - Country:US
Mailing Address - Phone:405-237-8333
Mailing Address - Fax:
Practice Address - Street 1:13439 BROADWAY EXT # 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2256
Practice Address - Country:US
Practice Address - Phone:405-237-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK10719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty