Stacey Simmons, MA, PHD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

110847 Issued in CA

Practice address

2211 W Magnolia Blvd # 145
Burbank, CA 91506-1753

Phone

(310) 853-3638

NPI assigned

Mar 16, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 12, 2024 through Jan 12, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544313600000",
    "number": "1407359326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33300 EASTERN AVE",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913902704",
            "telephone_number": "225-302-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 W MAGNOLIA BLVD # 145",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915061753",
            "telephone_number": "310-853-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "STACEY",
        "credential": "MA, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-16",
        "last_updated": "2018-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "110847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407359326",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter John Simic Jr., M.D.
• Jacleen Simjian
• Antonio Simmons
• Kathryn Simmons
• Laura Jean Simmons, LMFT
• Brenda Simonian
• Inga Simonian, PHD
• Manvel Simonyan
• Gabrielle Simpson Binion
• Atiyah Simpson

• Marriage & Family Therapist in Burbank, CA
• Providers in Burbank, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.