Provider Demographics
NPI:1568819654
Name:WEBSTER, SIMONIE INDRA (LPT)
Entity type:Individual
Prefix:MS
First Name:SIMONIE
Middle Name:INDRA
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2212
Mailing Address - Country:US
Mailing Address - Phone:916-642-7800
Mailing Address - Fax:
Practice Address - Street 1:592 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1817
Practice Address - Country:US
Practice Address - Phone:530-891-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2024-08-13
Deactivation Date:2024-04-16
Deactivation Code:
Reactivation Date:2024-08-09
Provider Licenses
StateLicense IDTaxonomies
CAPT40213167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician