Provider Demographics
NPI:1841936713
Name:SIMMONS, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
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 1:36439 PINEY RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5383
Mailing Address - Country:US
Mailing Address - Phone:352-272-3075
Mailing Address - Fax:
Practice Address - Street 1:2785 S BAY ST STE A
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6591
Practice Address - Country:US
Practice Address - Phone:844-668-6222
Practice Address - Fax:888-975-0599
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-232020106S00000X
FL1-25-83856103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician