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General NPI Number Information
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NPI Number | 1164887170
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Entity Type | Organization
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Legal Business Name | SUZAN B. SIMMONS, PH.D,,PLLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 1916 LAKE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-4800
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Country | US
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Telephone | 580-761-3799
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1230
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City | PONCA CITY
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State | OK
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Zip | 74602-1230
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Country | US
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Telephone | 580-761-3799
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SUZAN B SIMMONS
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Credential | PH.D.
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Telephone | 580-761-3799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1150
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License Number State | OK
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