1457844649 NPI number — MR. MICHAEL WILSON SIMMS LCSW, LAC, ADS

Table of content: JULIA HERRERA (NPI 1831503986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457844649 NPI number — MR. MICHAEL WILSON SIMMS LCSW, LAC, ADS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMS
Provider First Name:
MICHAEL
Provider Middle Name:
WILSON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LAC, ADS
Provider Gender Code:
M

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:
1457844649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 MADISON ST STE 308
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-656-5571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  ACD.0001089 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CSW.09926662 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW.09926662 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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