Provider Demographics
NPI:1144029968
Name:SIMMONS, MYRA J (MBA, CHWC, NCC, PLPC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:J
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MBA, CHWC, NCC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-4017
Mailing Address - Country:US
Mailing Address - Phone:662-760-0052
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-4017
Practice Address - Country:US
Practice Address - Phone:662-760-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health