MEDICARE: MARK ALLEN SIMMONS LPC, LCDC

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	11675	TX
2	101YP2500X	Professional Counselor	70873	TX

General Provider Information

NPI Number	:	1477059988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALLEN SIMMONS LPC, LCDC

Provider Business Mailing Address
First Line	:	29114 RED RIVER LOOP
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-3116
Country	:	US
Telephone Number	:	281-943-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 RESEARCH FOREST DR STE 130
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4252
Country	:	US
Telephone Number	:	281-528-4226
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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