Provider Demographics
NPI:1912277153
Name:SIMMONDS, KIM (LMFT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:SIMMONDS
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 S GAFFEY ST # 333
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-5324
Mailing Address - Country:US
Mailing Address - Phone:310-936-4311
Mailing Address - Fax:
Practice Address - Street 1:1840 S GAFFEY ST # 333
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-5324
Practice Address - Country:US
Practice Address - Phone:310-936-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF64492106H00000X
CALMFT89466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist