Provider Demographics
NPI:1285899906
Name:SIMMONS, SANDRA JUNE (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JUNE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 SOUTHEAST DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-4800
Mailing Address - Country:US
Mailing Address - Phone:210-724-2090
Mailing Address - Fax:
Practice Address - Street 1:4402 VANCE JACKSON RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5333
Practice Address - Country:US
Practice Address - Phone:210-724-2090
Practice Address - Fax:210-877-0939
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194926502Medicaid
TX88447QOtherBCBS TX
TX88447QOtherBCBS TX