Provider Demographics
NPI:1104670116
Name:SIMMONS, MELANIE N (BS)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:N
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RIVER HAVEN CIR # 821
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1242
Mailing Address - Country:US
Mailing Address - Phone:256-454-2981
Mailing Address - Fax:
Practice Address - Street 1:821 RIVER HAVEN CIR # 821
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1242
Practice Address - Country:US
Practice Address - Phone:256-454-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician