Healthcare Provider Details

I. General information

NPI: 1528219862
Provider Name (Legal Business Name): JULIE R. SIMMONDS AA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39477 LITTLE FALL CREEK RD
FALL CREEK OR
97438-9726
US

IV. Provider business mailing address

39477 LITTLE FALL CREEK RD
FALL CREEK OR
97438-9726
US

V. Phone/Fax

Practice location:
  • Phone: 541-988-4910
  • Fax: 541-747-4722
Mailing address:
  • Phone: 541-988-4910
  • Fax: 541-747-4722

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: