Provider Demographics
NPI:1609045806
Name:SIMPSON, CONNIE R (LPC , MHSP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LPC , MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PRINCETON RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2060
Mailing Address - Country:US
Mailing Address - Phone:423-302-3480
Mailing Address - Fax:423-722-3009
Practice Address - Street 1:508 PRINCETON RD
Practice Address - Street 2:SUITE 403
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2060
Practice Address - Country:US
Practice Address - Phone:423-302-3480
Practice Address - Fax:423-722-3009
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN601114265OtherMAGELLAN
TNQ024993Medicaid