Provider Demographics
NPI:1720585052
Name:SIMMONS, DONALD A (CAC II ACB0008328)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:CAC II ACB0008328
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-4368
Mailing Address - Country:US
Mailing Address - Phone:719-336-2600
Mailing Address - Fax:719-336-3669
Practice Address - Street 1:3501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-4368
Practice Address - Country:US
Practice Address - Phone:719-336-2600
Practice Address - Fax:719-336-3669
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)