Organization
SUZAN B. SIMMONS, PH.D,,PLLC
Active
Other names
Suzan B. Simmons, Ph.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUZAN B SIMMONS PH.D. (PSYCHOLOGIST)
(580) 761-3799
Entity
Organization
Contact information
Practice address
1916 LAKE RD, PONCA CITY, OK 74604-4800
(580) 761-3799
Mailing address
PO BOX 1230, PONCA CITY, OK 74602-1230
(580) 761-3799
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1150
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKA104155
MEDICARE INDIVIDUAL PTAN
OK
Enumeration date
12/17/2015
Last updated
12/17/2015
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