Healthcare Provider Details

I. General information

NPI: 1427540087
Provider Name (Legal Business Name): SAMANTHA SIMMONS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 PATRIOT BLVD STE 250
GLENVIEW IL
60026-8021
US

IV. Provider business mailing address

2700 PATRIOT BLVD STE 250
GLENVIEW IL
60026-8021
US

V. Phone/Fax

Practice location:
  • Phone: 630-707-3434
  • Fax:
Mailing address:
  • Phone: 630-707-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180012840
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178011415
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: