Provider Demographics
NPI:1609125608
Name:SIMMONS, SHANNON LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNN
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 1:1280 MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7374
Mailing Address - Country:US
Mailing Address - Phone:530-354-8586
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0799
Practice Address - Country:US
Practice Address - Phone:530-898-5923
Practice Address - Fax:530-898-4870
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA985811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical