Basic Information
| Provider Information | |||||||||
| NPI: | 1033646021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ANIKA | ||||||||
| MiddleName: | C | ||||||||
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| OtherLastName: | SIMMONS | ||||||||
| OtherFirstName: | ANIKA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 901 FAIRWAY DR | ||||||||
| Address2: | |||||||||
| City: | DUNCANVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751374613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148751816 | ||||||||
| FaxNumber: | 4695132719 | ||||||||
| Practice Location | |||||||||
| Address1: | 3341 YOUREE DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711052149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186210910 | ||||||||
| FaxNumber: | 3186210918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2017 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 81778 | TX | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 81778 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 81778 | TX | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 4619 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.