Individual
MELISSA SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1003 MARTIN LUTHER KING DR, BLOOMINGTON, IL 61701-1429
(309) 827-6026
Mailing address
1310 S OAK ST, BLOOMINGTON, IL 61701-6546
(309) 827-6026
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.005730
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
19945
IL
Other
Enumeration date
03/18/2014
Last updated
03/18/2014
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