Healthcare Provider Details

I. General information

NPI: 1558843573
Provider Name (Legal Business Name): ASHLEY LYNN SIMMONS MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 TROY SCHENECTADY RD STE 204
LATHAM NY
12110-1000
US

IV. Provider business mailing address

1182 TROY SCHENECTADY RD STE 204
LATHAM NY
12110-1000
US

V. Phone/Fax

Practice location:
  • Phone: 518-400-5180
  • Fax: 518-940-4420
Mailing address:
  • Phone: 518-400-5180
  • Fax: 518-940-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012640-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL5138
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC6230
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: