Provider Demographics
NPI:1053743419
Name:SIMS, KELLY S
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 SONFIELD ST
Mailing Address - Street 2:APT B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2152
Mailing Address - Country:US
Mailing Address - Phone:865-228-1445
Mailing Address - Fax:
Practice Address - Street 1:1616 L AND A RD
Practice Address - Street 2:SUITE 204
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6273
Practice Address - Country:US
Practice Address - Phone:504-832-5123
Practice Address - Fax:504-832-5133
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor