Provider Demographics
NPI:1558514695
Name:SIMMONS, LISA CAMILLE (MS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CAMILLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:CAMILLE
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12959 JUPITER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238
Mailing Address - Country:US
Mailing Address - Phone:682-333-1317
Mailing Address - Fax:
Practice Address - Street 1:12959 JUPITER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238
Practice Address - Country:US
Practice Address - Phone:682-333-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health