Healthcare Provider Details

I. General information

NPI: 1114216694
Provider Name (Legal Business Name): MR. JOSEPH HOUSTON SIMMONS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 N CLASSEN BLVD STE 101
OKLAHOMA CITY OK
73118-5258
US

IV. Provider business mailing address

PO BOX 235
LANGSTON OK
73050-0235
US

V. Phone/Fax

Practice location:
  • Phone: 817-691-7701
  • Fax:
Mailing address:
  • Phone: 817-691-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: