Provider Demographics
NPI:1215401914
Name:SIMMONS COUNSELING AND CONSULTING SERVICES, PC
Entity Type:Organization
Organization Name:SIMMONS COUNSELING AND CONSULTING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:872-216-3241
Mailing Address - Street 1:53 W JACKSON BLVD STE 1636
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3729
Mailing Address - Country:US
Mailing Address - Phone:872-216-3241
Mailing Address - Fax:312-625-1548
Practice Address - Street 1:53 W JACKSON BLVD STE 1636
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3729
Practice Address - Country:US
Practice Address - Phone:872-216-3241
Practice Address - Fax:312-625-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL972258556OtherBCBS