Healthcare Provider Details

I. General information

NPI: 1124358676
Provider Name (Legal Business Name): ASHLEY ANN SIMMONS MS LPC-S, LADC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY ANN REYNOLDS MS LPC-S, LADC-C

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E 24TH ST
TISHOMINGO OK
73460-3214
US

IV. Provider business mailing address

1300 HOPPE BLVD STE 6
ADA OK
74820-2319
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-3672
  • Fax:
Mailing address:
  • Phone: 580-310-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7061
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: