Provider Demographics
NPI:1285824870
Name:SIMMONS, DORA ELLEN (LMHC NCC)
Entity type:Individual
Prefix:MRS
First Name:DORA
Middle Name:ELLEN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMHC NCC
Other - Prefix:MRS
Other - First Name:DORA
Other - Middle Name:ELLEN
Other - Last Name:SIMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4712 SOUTH ADAMS
Mailing Address - Street 2:#100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118
Mailing Address - Country:US
Mailing Address - Phone:206-722-5001
Mailing Address - Fax:206-760-0250
Practice Address - Street 1:4712 SOUTH ADAMS
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118
Practice Address - Country:US
Practice Address - Phone:206-722-5001
Practice Address - Fax:206-760-0250
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0000672OtherMH STATE
48057OtherNATIONAL BOARD CERTIFIED