Provider Demographics
NPI:1689055725
Name:SIMMONS, GINA MARIE (LPC,CAC III, MA)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPC,CAC III, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5866
Mailing Address - Country:US
Mailing Address - Phone:970-599-1523
Mailing Address - Fax:
Practice Address - Street 1:2956 GINNALA DR STE 205
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7825
Practice Address - Country:US
Practice Address - Phone:907-599-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0020880101YA0400X
COLPC.0015178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
COEINOtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES