Provider Demographics
NPI:1912201567
Name:SIMMONS, BETHANY (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SAND ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9754
Mailing Address - Country:US
Mailing Address - Phone:318-267-2193
Mailing Address - Fax:
Practice Address - Street 1:1300 HUDSON LN
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6066
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:318-322-5118
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist