Individual
JUSTIN SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
701 CEDAR LAKE BLVD STE 120, OKLAHOMA CITY, OK 73114-7815
(405) 445-1210
(405) 445-3310
Mailing address
112 N UNIVERSITY AVE, ENID, OK 73701-4654
(580) 541-9792
(580) 701-4312
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4564
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200379060A
—
OK
Enumeration date
06/01/2011
Last updated
04/19/2022
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