Provider Demographics
NPI:1033646021
Name:SIMMONS, ANIKA C
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:C
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANIKA
Other - Middle Name:C
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4613
Mailing Address - Country:US
Mailing Address - Phone:214-875-1816
Mailing Address - Fax:469-513-2719
Practice Address - Street 1:3341 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2149
Practice Address - Country:US
Practice Address - Phone:318-621-0910
Practice Address - Fax:318-621-0918
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX81778101Y00000X, 101YM0800X, 101YP2500X
LA4619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health