Provider Demographics
NPI:1043610660
Name:SIMMONS, CYNTHIA (LCSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97467-0813
Mailing Address - Country:US
Mailing Address - Phone:541-271-0060
Mailing Address - Fax:541-982-7028
Practice Address - Street 1:464 FIR AVE
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1427
Practice Address - Country:US
Practice Address - Phone:541-271-0060
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL8409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health