Provider Demographics
NPI:1194961243
Name:SIMMONS JANSEN, SHAKIRA MARINI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAKIRA
Middle Name:MARINI
Last Name:SIMMONS JANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 LINCOLN AVE STE D440
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3463
Mailing Address - Country:US
Mailing Address - Phone:714-699-4465
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:VISN 22 TELEMENTAL HEALTH
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-625-9357
Practice Address - Fax:267-908-6605
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30754103TC0700X
AZ3960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical