Provider Demographics
NPI:1063897809
Name:SIMMERMAN, RIANNON LYNN (LIMHP, PLADC)
Entity type:Individual
Prefix:MRS
First Name:RIANNON
Middle Name:LYNN
Last Name:SIMMERMAN
Suffix:
Gender:F
Credentials:LIMHP, PLADC
Other - Prefix:MISS
Other - First Name:RIANNON
Other - Middle Name:LYNN
Other - Last Name:JEFFERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLMHP, PLADC
Mailing Address - Street 1:11920 BURT STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:402-965-4232
Practice Address - Street 1:11920 BURT STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:402-965-4232
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2049101YM0800X
NEP-1334101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)