Healthcare Provider Details

I. General information

NPI: 1154532554
Provider Name (Legal Business Name): CARRIE B SIMMONS M.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SPRING ST
CHATTANOOGA TN
37405-3848
US

IV. Provider business mailing address

2326 MIDLAND ROAD
SHELBYVILLE TN
37160
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-2740
  • Fax:
Mailing address:
  • Phone: 423-756-2740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: