Provider Demographics
NPI:1578824413
Name:SUSAN V SIMS, LLC
Entity Type:Organization
Organization Name:SUSAN V SIMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-874-0608
Mailing Address - Street 1:3601 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2805
Mailing Address - Country:US
Mailing Address - Phone:813-874-0608
Mailing Address - Fax:813-350-9544
Practice Address - Street 1:3601 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2805
Practice Address - Country:US
Practice Address - Phone:813-874-0608
Practice Address - Fax:813-350-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000048900Medicaid
FL1407907017OtherINDIVIDUAL NPI