Jonathan Alan Simons PHD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

639 Issued in SC

Legal business name

JONATHAN ALAN SIMONS PHD PC

Practice address

1506 Azalea Dr
Ste 602
Surfside Beach, SC 29575-5232

Phone

(843) 828-0502

Fax

(843) 828-4402

NPI assigned

May 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Patricia Claire Stelling

Title

Vice President-Office Manager

Phone

(843) 828-0502

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1104048925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 859",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295850859",
            "telephone_number": "843-828-0502",
            "fax_number": "843-828-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 AZALEA DR",
            "address_2": "STE 602",
            "city": "SURFSIDE BEACH",
            "state": "SC",
            "postal_code": "295755232",
            "telephone_number": "843-828-0502",
            "fax_number": "843-828-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN ALAN SIMONS PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "STELLING",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "CLAIRE",
        "authorized_official_title_or_position": "VICE PRESIDENT-OFFICE MANAGER",
        "authorized_official_telephone_number": "843-828-0502",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PS0245",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Surfside Beach, SC
• Clinical Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.