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General NPI Number Information
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NPI Number | 1215401914
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Entity Type | Organization
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Legal Business Name | SIMMONS COUNSELING AND CONSULTING SERVICES, PC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 1636
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City | CHICAGO
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State | IL
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Zip | 60604-3729
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Country | US
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Telephone | 872-216-3241
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Fax | 312-625-1548
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Provider Business Mailing Address
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Address Line | 53 W JACKSON BLVD STE 1636
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City | CHICAGO
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State | IL
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Zip | 60604-3729
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Country | US
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Telephone | 872-216-3241
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Fax | 312-625-1548
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DANIELLE SIMMONS
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Credential | PHD
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Telephone | 872-216-3241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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