Provider Demographics
NPI:1306972401
Name:SIMPSON, CHRISTINE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:S
Last Name:SIMPSON
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 1:9255 W 00 NS
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901
Mailing Address - Country:US
Mailing Address - Phone:765-434-3531
Mailing Address - Fax:765-553-5772
Practice Address - Street 1:1810 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5737
Practice Address - Country:US
Practice Address - Phone:765-553-5691
Practice Address - Fax:765-553-5772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004650A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154150AMedicaid
IN225230GMedicare ID - Type Unspecified
IN100154150AMedicaid