Provider Demographics
NPI:1598898686
Name:SIMMONS, VICKI I (LPC)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:I
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:DOUBET SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63006-0123
Mailing Address - Country:US
Mailing Address - Phone:314-323-3373
Mailing Address - Fax:636-391-3323
Practice Address - Street 1:315 STEPHANIE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:314-323-3373
Practice Address - Fax:636-391-3323
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
7066375OtherAETNA PIN NUMBER
11618683OtherCAQH NUMBER UBH
147131OtherBLUE CROSS PIN NUMBER
304490OtherMHN PIN