Provider Demographics
NPI:1487202040
Name:SIMMONS, MYRA R
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:R
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 VILLAGE BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7439
Mailing Address - Country:US
Mailing Address - Phone:561-713-6600
Mailing Address - Fax:
Practice Address - Street 1:3515 VILLAGE BLVD APT 303
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7439
Practice Address - Country:US
Practice Address - Phone:561-713-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health