Provider Demographics
NPI:1588902969
Name:SIMMONS, KRYSTAL T (LSSP, NCSP, LP)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:T
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LSSP, NCSP, LP
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:T
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSSP, LP
Mailing Address - Street 1:2130 HARVEY MITCHELL PKWY S
Mailing Address - Street 2:SUITE 11112
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5103
Mailing Address - Country:US
Mailing Address - Phone:832-800-3449
Mailing Address - Fax:
Practice Address - Street 1:2130 HARVEY MITCHELL PKWY S
Practice Address - Street 2:SUITE 11112
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5103
Practice Address - Country:US
Practice Address - Phone:832-800-3449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36257103T00000X
TX34572103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool