MEDICARE: MR. MICHAEL WILSON SIMMS LCSW, LAC, ADS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001089	CO
2	101YM0800X	Mental Health Counselor	CSW.09926662	CO
3	1041C0700X	Clinical Social Worker	CSW.09926662	CO

General Provider Information

NPI Number	:	1457844649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL WILSON SIMMS LCSW, LAC, ADS

Provider Business Mailing Address
First Line	:	17095 E 105TH AVE
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-0570
Country	:	US
Telephone Number	:	720-656-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 MADISON ST STE 308
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5412
Country	:	US
Telephone Number	:	720-656-5571
Fax Number	:

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

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	10/10/2024

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