Provider Demographics
NPI:1962912105
Name:SIMMONS, CUYLER ANN (MSW, LSWAIC, CDPT)
Entity type:Individual
Prefix:MS
First Name:CUYLER
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSW, LSWAIC, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 108TH AVE NE STE 204
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-7613
Mailing Address - Country:US
Mailing Address - Phone:425-242-1713
Mailing Address - Fax:425-242-0587
Practice Address - Street 1:3805 108TH AVE NE STE 204
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-242-1713
Practice Address - Fax:425-242-0587
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60877922101YA0400X
WASC608791401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)