Provider Demographics
NPI:1437442977
Name:SIMMONS, BROOKLYNN (BCABA)
Entity Type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 HEATHERPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5302 S FLORIDA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4922
Practice Address - Country:US
Practice Address - Phone:863-937-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-10-3776103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst