Provider Demographics
NPI:1669748463
Name:SIMMONS, TIFFANY L
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:SIMMONS
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 1:2783 HERRON HILLS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-4780
Mailing Address - Country:US
Mailing Address - Phone:702-979-8283
Mailing Address - Fax:
Practice Address - Street 1:3450 E RUSSELL RD
Practice Address - Street 2:SUITE #213
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-979-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst