Provider Demographics
NPI:1386805943
Name:SIMO, JORDAN
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:SIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 DURANT CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6405
Mailing Address - Country:US
Mailing Address - Phone:310-367-4599
Mailing Address - Fax:
Practice Address - Street 1:1 SANTA BARBARA RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4215
Practice Address - Country:US
Practice Address - Phone:925-256-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor