MEDICARE: BEVERLY EDWARDS SIMMONS

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

General Provider Information

NPI Number	:	1447185012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY EDWARDS SIMMONS

Provider Business Mailing Address
First Line	:	7406 DONLON RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1769
Country	:	US
Telephone Number	:	954-830-8719
Fax Number	:	954-830-8719

Provider Business Practice Location Address
First Line	:	2011 S 25TH ST STE 108
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4795
Country	:	US
Telephone Number	:	772-242-1079
Fax Number	:	772-242-1296

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ BEVERLY EDWARDS SIMMONS ” Practice Location

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