Provider Demographics
NPI:1487703443
Name:SIMMONS, MARK ALLEN (MSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD STE 1504
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4805
Mailing Address - Country:US
Mailing Address - Phone:210-647-7907
Mailing Address - Fax:210-647-7805
Practice Address - Street 1:7272 WURZBACH RD STE 1504
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4805
Practice Address - Country:US
Practice Address - Phone:210-647-7907
Practice Address - Fax:210-647-7805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S39UMedicare UPIN