Provider Demographics
NPI:1265434666
Name:SIMONS, KOLLEEN L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KOLLEEN
Middle Name:L
Last Name:SIMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HILLTOP VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1106
Mailing Address - Country:US
Mailing Address - Phone:314-374-1620
Mailing Address - Fax:636-587-3742
Practice Address - Street 1:9 HILLTOP VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1106
Practice Address - Country:US
Practice Address - Phone:314-374-1620
Practice Address - Fax:636-587-3742
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030004061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495864704Medicaid
MO990001832Medicare ID - Type Unspecified