Provider Demographics
NPI:1053529370
Name:SIMPSON, KACIE
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W SHAW AVE
Mailing Address - Street 2:116
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3401
Mailing Address - Country:US
Mailing Address - Phone:559-712-1659
Mailing Address - Fax:
Practice Address - Street 1:2350 W SHAW AVE
Practice Address - Street 2:116
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3401
Practice Address - Country:US
Practice Address - Phone:559-712-1659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91326106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor