MEDICARE: VICKI SIMMONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	MI0844	NV
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1366957367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI SIMMONS

Provider Business Mailing Address
First Line	:	4965 GHOST DANCE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4965 GHOST DANCE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4794
Country	:	US
Telephone Number	:	702-900-7114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	07/30/2020

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Directions to “ VICKI SIMMONS ” Practice Location

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