Provider Demographics
NPI:1205194099
Name:SIMMONS, DAVID BRIAN (BA, LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:BA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 N BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1727
Mailing Address - Country:US
Mailing Address - Phone:316-409-5242
Mailing Address - Fax:
Practice Address - Street 1:4031 E HARRY ST STE 43
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3724
Practice Address - Country:US
Practice Address - Phone:316-771-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS558101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)