Provider Demographics
NPI:1477059988
Name:SIMMONS, MARK ALLEN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29114 RED RIVER LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3116
Mailing Address - Country:US
Mailing Address - Phone:281-943-4664
Mailing Address - Fax:
Practice Address - Street 1:2700 RESEARCH FOREST DR STE 130
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4252
Practice Address - Country:US
Practice Address - Phone:281-528-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11675101YA0400X
TX70873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)