Healthcare Provider Details

I. General information

NPI: 1922165562
Provider Name (Legal Business Name): MELISSA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 COMMERCIAL CENTER DR STE 2
MARION AR
72364-9616
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-7920
  • Fax: 870-732-7923
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2205010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: