Provider Demographics
NPI:1356991855
Name:SIMMONS, BRIAN MARC (LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARC
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STRAIGHT CREEK CT
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5440
Mailing Address - Country:US
Mailing Address - Phone:214-226-4206
Mailing Address - Fax:
Practice Address - Street 1:2131 KIRKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1529
Practice Address - Country:US
Practice Address - Phone:214-226-4206
Practice Address - Fax:817-402-2437
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX69257OtherCOUNSELING LICENSE