Provider Demographics
NPI:1396247375
Name:SIMMONS, LAURA G
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LAYNE
Other - Last Name:GWYNNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3285 E SKILLERN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4626
Mailing Address - Country:US
Mailing Address - Phone:479-966-9895
Mailing Address - Fax:
Practice Address - Street 1:1814 S 26TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1386
Practice Address - Country:US
Practice Address - Phone:479-966-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1803029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health