Provider Demographics
NPI:1538370960
Name:SIMS, GARY SCOTT (SUDP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:SCOTT
Last Name:SIMS
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0508
Mailing Address - Country:US
Mailing Address - Phone:360-360-7091
Mailing Address - Fax:707-274-4628
Practice Address - Street 1:PO BOX 508
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568-0508
Practice Address - Country:US
Practice Address - Phone:360-709-1661
Practice Address - Fax:707-274-4628
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)