Provider Demographics
NPI:1841313905
Name:SIMMONS, DEBORAH SUSAN (PH D, LMFT)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUSAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PH D, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2059
Mailing Address - Country:US
Mailing Address - Phone:612-324-1207
Mailing Address - Fax:612-500-4459
Practice Address - Street 1:414 PENN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2059
Practice Address - Country:US
Practice Address - Phone:612-324-1207
Practice Address - Fax:612-500-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN917OtherSTATE LICENSE