Healthcare Provider Details

I. General information

NPI: 1801429824
Provider Name (Legal Business Name): JOSEPH SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 S HILL ST UNIT A
GLOBE AZ
85501-2436
US

IV. Provider business mailing address

354 S HILL ST UNIT A
GLOBE AZ
85501-2436
US

V. Phone/Fax

Practice location:
  • Phone: 570-764-5224
  • Fax:
Mailing address:
  • Phone: 570-764-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-18019
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: