Provider Demographics
NPI:1154606929
Name:SIMPSON, DEBORA JEAN
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:JEAN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WILLIAM D TATE AVE STE 800A
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:773-294-9139
Mailing Address - Fax:855-295-2686
Practice Address - Street 1:200 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3963
Practice Address - Country:US
Practice Address - Phone:817-488-8998
Practice Address - Fax:855-295-2686
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007321101YM0800X
TX76606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health