Healthcare Provider Details

I. General information

NPI: 1003428392
Provider Name (Legal Business Name): DANIELLA LUCILLE SIMMONS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 E WASHINGTON ST STE 212
PHOENIX AZ
85034-7439
US

IV. Provider business mailing address

5025 E WASHINGTON ST STE 212
PHOENIX AZ
85034-7439
US

V. Phone/Fax

Practice location:
  • Phone: 602-773-5775
  • Fax:
Mailing address:
  • Phone: 602-773-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001028
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-112210
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: