Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 28239 | CA |
Y | 103T00000X | Psychologist | PSY 28239 | CA |
NPI | 1013465194 |
---|---|
Provider Name | Dr. Terry Simpson |
First Address | Beverly Hills, CA 90212-2931 |
Second Address | Beverly Hills, CA 90212-2931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2016 |
Last Update Date | 16/09/2016 |