Provider Demographics
NPI:1942555651
Name:SIMMONS, JAMES CLARENCE (PSYD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CLARENCE
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 JACKSON STREET NW
Mailing Address - Street 2:JAMES C SIMMONS
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5322
Mailing Address - Country:US
Mailing Address - Phone:423-280-3186
Mailing Address - Fax:423-790-5299
Practice Address - Street 1:205 JACKSON ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5322
Practice Address - Country:US
Practice Address - Phone:423-280-3186
Practice Address - Fax:423-790-5299
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011139101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor