MEDICARE: JOY LOREE SIMMONS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701007717	VA

General Provider Information

NPI Number	:	1083191357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY LOREE SIMMONS LPC

Provider Business Mailing Address
First Line	:	180 W MAIN ST
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2330
Country	:	US
Telephone Number	:	276-335-2243
Fax Number	:	276-228-6064

Provider Business Practice Location Address
First Line	:	180 W MAIN ST
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-2330
Country	:	US
Telephone Number	:	276-335-2243
Fax Number	:	276-228-6064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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