Provider Demographics
NPI:1316423940
Name:SIMMONS, TRACI (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 STUBBS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5631
Mailing Address - Country:US
Mailing Address - Phone:318-582-5633
Mailing Address - Fax:318-582-5646
Practice Address - Street 1:1204 STUBBS AVE STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5631
Practice Address - Country:US
Practice Address - Phone:318-582-5633
Practice Address - Fax:318-582-5646
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4633101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor