Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | CA LIC NO PSY4045 | CA |
N | 103T00000X | Psychologist | CA LIC NO PSY4045 | CA |
N | 103G00000X | Clinical Psychologist | PSY4045 | CA |
N | 103TC0700X | Clinical Psychologist | PSY4045 | CA |
N | 103TC1900X | Counseling Psychologist | PSY4045 | CA |
NPI | 1114067618 |
---|---|
Provider Name | Dr. Gregory M Sims |
First Address | Boonville, CA 95415 |
Second Address | Philo, CA 95466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PL40451 | (05) | CA |
1147037 | (02) |