Mark Theodore Simpson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3205 Issued in TN

Practice address

119 Boone Ridge Dr
Suite 201
Johnson City, TN 37615

Phone

(865) 673-6741

Fax

(865) 673-6634

NPI assigned

Apr 8, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1175990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1285757013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 25TH AVE N STE 204",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032492",
            "telephone_number": "615-385-4090",
            "fax_number": "615-385-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BOONE RIDGE DR",
            "address_2": "SUITE 201",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37615",
            "telephone_number": "865-673-6741",
            "fax_number": "865-673-6634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Boone Ridge Dr",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376154998",
            "country_code": "US",
            "telephone_number": "865-673-6741",
            "fax_number": "865-673-6634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "MARK",
        "middle_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-08",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "3205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Simonsen, PT
• Simple Smiles, P.C.
• Charslee Simpson, CRNA
• Connie R. Simpson, LPC , MHSP
• Kathryn A Simpson, LPC, MHSP
• Vanessa C Sims, CRNA
• Willard Douglas Sims, MA LMFT
• Stacy Sindon
• Lauren C Sineath, R.D. L.D.
• Sakshi Singal, M.D.

• All providers in Johnson City, TN
• Clinical Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.