MEDICARE: CARLATA JONAE SIMMONS PSR

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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1801741426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLATA JONAE SIMMONS PSR

Provider Business Mailing Address
First Line	:	2502 RIVERSIDE PKWY APT 716
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-7978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 MATLOCK RD STE 210
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-3600
Country	:	US
Telephone Number	:	214-725-8732
Fax Number	:

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

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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