Provider Demographics
NPI:1629123625
Name:SIMMONS, SAMANTHA ANN (LPCC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPCC, LCADC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 ROLLING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9005
Mailing Address - Country:US
Mailing Address - Phone:606-343-0216
Mailing Address - Fax:066-343-0224
Practice Address - Street 1:80 ROLLING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9005
Practice Address - Country:US
Practice Address - Phone:066-343-0216
Practice Address - Fax:606-343-0224
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166494101YA0400X
KY105683101YP2500X
KY834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100277600Medicaid
KY30615058Medicaid