MEDICARE: LAURA A. SIMMONS MFT

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	106H00000X	Marriage & Family Therapist	0911	NV

General Provider Information

NPI Number	:	1104847680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A. SIMMONS MFT

Provider Business Mailing Address
First Line	:	2649 W HORIZON RIDGE PKWY
Second Line	:	SUITE 130
City	:	HENDERSON
State	:	NV
Zip	:	89052-4801
Country	:	US
Telephone Number	:	702-260-6203
Fax Number	:	702-796-9490

Provider Business Practice Location Address
First Line	:	2649 W HORIZON RIDGE PKWY
Second Line	:	SUITE 130
City	:	HENDERSON
State	:	NV
Zip	:	89052-4801
Country	:	US
Telephone Number	:	702-260-6203
Fax Number	:	702-796-9490

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	04/28/2008

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