Provider Demographics
NPI:1578177242
Name:SIMMONS, IMMANUEL IMAN
Entity Type:Individual
Prefix:
First Name:IMMANUEL
Middle Name:IMAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 GETWELL RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2205
Mailing Address - Country:US
Mailing Address - Phone:901-834-3866
Mailing Address - Fax:
Practice Address - Street 1:3000 GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2205
Practice Address - Country:US
Practice Address - Phone:901-422-6000
Practice Address - Fax:901-542-0167
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health