Provider Demographics
NPI:1083756258
Name:SIMCOX, LARRY (PHD MA MDIV LMFT)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:SIMCOX
Suffix:
Gender:M
Credentials:PHD MA MDIV LMFT
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:LAWRENCE
Other - Last Name:SIMCOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:ONE NORTH 121 FARWELL ST
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-653-5405
Mailing Address - Fax:
Practice Address - Street 1:ONE NORTH 121 FARWELL ST
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188
Practice Address - Country:US
Practice Address - Phone:630-653-5405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632910OtherBCBS OF ILLINOIS