Provider Demographics
NPI:1790309854
Name:SIMMONS, KATHY (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14137 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8355
Mailing Address - Country:US
Mailing Address - Phone:314-579-1612
Mailing Address - Fax:
Practice Address - Street 1:249 LAMP AND LANTERN VILLAGE
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-899-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health