Basic Information
| Provider Information | |||||||||
| NPI: | 1891189916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS-JOHNSON | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8326 MAIN ST BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703634871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
| FaxNumber: | 9858688547 | ||||||||
| Practice Location | |||||||||
| Address1: | 5593 HIGHWAY 311 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703602866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
| FaxNumber: | 9858688547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 12820 | LA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | 12820 | LA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.