MEDICARE: RICHARD SIMMS LMSW

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	1041C0700X	Clinical Social Worker	6801087747	MI

General Provider Information

NPI Number	:	1477067916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD SIMMS LMSW

Provider Business Mailing Address
First Line	:	2424 W WASHINGTON AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 W WASHINGTON AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-1236
Country	:	US
Telephone Number	:	517-205-2732
Fax Number	:

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

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	11/20/2017

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