Provider Demographics
NPI:1831468776
Name:SIMMONS, LANA E
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 AUBURN WAY S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6132
Mailing Address - Country:US
Mailing Address - Phone:253-939-2202
Mailing Address - Fax:253-735-1894
Practice Address - Street 1:1000 AUBURN WAY S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6132
Practice Address - Country:US
Practice Address - Phone:253-939-2202
Practice Address - Fax:253-735-1894
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALM60548285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist