Provider Demographics
NPI:1942625819
Name:SIMMONS, JEANNETTE K (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:K
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 IROQUOIS TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4308
Mailing Address - Country:US
Mailing Address - Phone:386-956-2133
Mailing Address - Fax:
Practice Address - Street 1:5 IROQUOIS TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4308
Practice Address - Country:US
Practice Address - Phone:386-956-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor