Individual
MICAH FITZSIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
655 MAPLE AVE, LOS ANGELES, CA 90014-2211
(951) 444-0965
Mailing address
655 MAPLE AVE, LOS ANGELES, CA 90014-2211
(951) 444-0965
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
175T00000X
Peer Specialist
Primary
MPSS-GYRHLS
CA
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
04/07/2025
Last updated
05/29/2026
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