Basic Information
| Provider Information | |||||||||
| NPI: | 1003012469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17838 GLENAPP DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138435452 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17838 GLENAPP DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138435452 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW5867 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.