Provider Demographics
NPI:1124761887
Name:SIMMONS, KIMBERLY (LMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:TRAXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 601422
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-1422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7077 BONNEVAL RD STE 603
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6010
Practice Address - Country:US
Practice Address - Phone:877-840-6956
Practice Address - Fax:619-383-6701
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health