Provider Demographics
NPI:1053534933
Name:SIMMONS, JENNIFER MARIE (LPCC-S)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SIMMONS-MEANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC
Mailing Address - Street 1:15717 LOTUS DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2426
Mailing Address - Country:US
Mailing Address - Phone:216-991-1161
Mailing Address - Fax:
Practice Address - Street 1:2121 E 32ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2747
Practice Address - Country:US
Practice Address - Phone:440-260-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH975946101YA0400X
OHE0001716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional