Healthcare Provider Details

I. General information

NPI: 1215483912
Provider Name (Legal Business Name): JESSICA LYNN SIMMONS LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MAIN ST SUITE, 100
DALLAS TX
75201-4366
US

IV. Provider business mailing address

2121 MAIN ST SUITE, 100
DALLAS TX
75201-4366
US

V. Phone/Fax

Practice location:
  • Phone: 214-331-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13046
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: