Provider Demographics
NPI:1295964245
Name:SIMMONS, JENNIFER D (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-0122
Mailing Address - Country:US
Mailing Address - Phone:573-528-3168
Mailing Address - Fax:573-774-3711
Practice Address - Street 1:19871 SACKETT LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-0122
Practice Address - Country:US
Practice Address - Phone:573-528-3168
Practice Address - Fax:573-774-3711
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO500676101YA0400X
MO2009009104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)