1114416823 NPI number — JULIE SIMMONS MS LPC LLC

Table of content: (NPI 1114416823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114416823 NPI number — JULIE SIMMONS MS LPC LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
JULIE SIMMONS MS LPC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114416823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
353 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOLA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17540-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-454-3832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17540-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-454-3832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST/OWNER
Authorized Official Telephone Number:
717-454-3832

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC007647 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1679987473 . This is a "MENTAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".