Provider Demographics
NPI:1922772961
Name:SIMMONS, EMILY ROSE (RBT, BHT)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ROSE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RBT, BHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E WARNER RD APT 64
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2301
Mailing Address - Country:US
Mailing Address - Phone:480-648-6629
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 420
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2472
Practice Address - Country:US
Practice Address - Phone:480-474-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-21-178474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician