Provider Demographics
NPI:1235561366
Name:SIMONS-BRACKEN, NICHOLAS ALVIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ALVIN
Last Name:SIMONS-BRACKEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 SE BAYBERRY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-500-6436
Mailing Address - Fax:
Practice Address - Street 1:668 SE BAYBERRY LN STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-500-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170119871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical