Provider Demographics
NPI:1558845735
Name:SIMMONS, BRYAN ALAN (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ALAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16379 E PRESERVE LOOP UNIT 2054
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-9402
Mailing Address - Country:US
Mailing Address - Phone:714-323-4299
Mailing Address - Fax:
Practice Address - Street 1:16379 E PRESERVE LOOP UNIT 2054
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-9402
Practice Address - Country:US
Practice Address - Phone:714-323-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60914242103K00000X
KS189103K00000X
MO2018027335103K00000X
1-18-29851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst