Provider Demographics
NPI:1124358585
Name:SIMMON, BRYAN NICHOLAS (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:NICHOLAS
Last Name:SIMMON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-2506
Mailing Address - Country:US
Mailing Address - Phone:877-375-3484
Mailing Address - Fax:
Practice Address - Street 1:3510 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-2506
Practice Address - Country:US
Practice Address - Phone:877-375-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional