Provider Demographics
NPI:1962832832
Name:SIMMONS, NICOLAS
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 VISTA BLVD
Mailing Address - Street 2:#200
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2863
Mailing Address - Country:US
Mailing Address - Phone:866-832-3015
Mailing Address - Fax:
Practice Address - Street 1:4860 VISTA BLVD
Practice Address - Street 2:#200
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2863
Practice Address - Country:US
Practice Address - Phone:866-832-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst