Healthcare Provider Details

I. General information

NPI: 1962912105
Provider Name (Legal Business Name): CUYLER ANN SIMMONS MSW, LSWAIC, CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 108TH AVE NE STE 204
BELLEVUE WA
98004
US

IV. Provider business mailing address

3805 108TH AVE NE STE 204
BELLEVUE WA
98004-7613
US

V. Phone/Fax

Practice location:
  • Phone: 425-242-1713
  • Fax: 425-242-0587
Mailing address:
  • Phone: 425-242-1713
  • Fax: 425-242-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60877922
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60879140
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: