Provider Demographics
NPI:1891705901
Name:SIMMONS, CHRISTOPHER ELLIOT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ELLIOT
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-967-3866
Mailing Address - Fax:541-812-8812
Practice Address - Street 1:799 LONG ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386
Practice Address - Country:US
Practice Address - Phone:541-367-3888
Practice Address - Fax:541-367-2407
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 145231041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL5730OtherLCSW
ZZZ39012ZMedicare ID - Type UnspecifiedIND NUMBER
A42821Medicare UPIN
ORL5730OtherLCSW