Provider Demographics
NPI:1245381615
Name:SIMMONS, SUE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 GLADYS AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-8202
Mailing Address - Country:US
Mailing Address - Phone:409-860-9397
Mailing Address - Fax:409-860-0223
Practice Address - Street 1:8109 GLADYS AVE
Practice Address - Street 2:STE. 102
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-8202
Practice Address - Country:US
Practice Address - Phone:409-860-9397
Practice Address - Fax:409-860-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21926OtherLCSW
TXS33XMedicare ID - Type UnspecifiedLCSW