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NPI Code Detail

MEDICARE: FELICIA LATRICE SIMMONS-PETERSON QMHP

MEDICARE: FELICIA LATRICE SIMMONS-PETERSON QMHP
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
1251B00000XCase Management Agency
2101YP2500XProfessional Counselor94668TX

General Provider Information

NPI Number : 1952771909
Entity Type Code : Individual
Provider Name (Legal Business Name) : FELICIA LATRICE SIMMONS-PETERSON QMHP
Provider Business Mailing Address
First Line : 5501 BOVINE DR APT 7202
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-0017
Country : US
Telephone Number : 318-229-3579
Fax Number :
Provider Business Practice Location Address
First Line : 5501 BOVINE DR APT 7202
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-0017
Country : US
Telephone Number : 318-229-3579
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2015
Last Update Date : 11/27/2024

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Directions to “ FELICIA LATRICE SIMMONS-PETERSON QMHP” Practice Location

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