Provider Demographics
NPI:1942967260
Name:SIMMONS-HART, VICKEY LYNN
Entity Type:Individual
Prefix:
First Name:VICKEY
Middle Name:LYNN
Last Name:SIMMONS-HART
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 1:4509 W HASAN DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-1960
Mailing Address - Country:US
Mailing Address - Phone:480-532-8214
Mailing Address - Fax:
Practice Address - Street 1:4509 W HASAN DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-1960
Practice Address - Country:US
Practice Address - Phone:480-532-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty