Healthcare Provider Details

I. General information

NPI: 1124761887
Provider Name (Legal Business Name): KIMBERLY SIMMONS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY TRAXLER LMHC

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E STATE ROAD 100
SAN MATEO FL
32187-2371
US

IV. Provider business mailing address

617 E STATE ROAD 100
SAN MATEO FL
32187-2371
US

V. Phone/Fax

Practice location:
  • Phone: 386-937-4463
  • Fax:
Mailing address:
  • Phone: 386-937-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: