Provider Demographics
NPI:1235586843
Name:SIMS, KELVIN
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8349 SATINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8349 SATINWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:LA
Practice Address - Zip Code:71033-3228
Practice Address - Country:US
Practice Address - Phone:318-938-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health