Provider Demographics
NPI:1760737902
Name:SIMMONS, DEE A (CADC I)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MELISSA ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1521
Mailing Address - Country:US
Mailing Address - Phone:503-623-9263
Mailing Address - Fax:
Practice Address - Street 1:3325 HAROLD DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1339
Practice Address - Country:US
Practice Address - Phone:503-399-5597
Practice Address - Fax:503-316-9740
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-06-70101YA0400X
OR101YM0800X
ORG 14-12-02101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor