Provider Demographics
NPI:1588606925
Name:SIMMONS, BROOKE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6035
Mailing Address - Country:US
Mailing Address - Phone:801-755-2122
Mailing Address - Fax:801-292-0268
Practice Address - Street 1:406 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6035
Practice Address - Country:US
Practice Address - Phone:801-755-2122
Practice Address - Fax:801-292-0268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4769110-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health