Provider Demographics
NPI:1396039079
Name:SIMMONS, BRIDGET RANEE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RANEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:RANEE
Other - Last Name:SELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31138 S 4425 DR
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-7832
Mailing Address - Country:US
Mailing Address - Phone:918-323-2120
Mailing Address - Fax:
Practice Address - Street 1:31138 S 4425 DR
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7832
Practice Address - Country:US
Practice Address - Phone:918-323-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTEMP101YM0800X
OK5161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health