Doctor Name: | BRIDGET RANEE SIMMONS |
NPI Number: | 1396039079 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | TEMP |
Business Practice Address: | 31138 S 4425 Dr Vinita, OK - 743017832 |
Business Phone Number: | 9183232120 |
Business Fax Number: | |
Mailing Address: | 31138 S 4425 Dr, VINITA |
State: | OK |
Postal Code: | 743017832 |
Phone Number: | 9183232120 |
Fax Number: | |
NPI Enumeration Date: | 05/31/2011 |
NPI Last Update Date: | 10/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | TEMP |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |