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:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8140
Mailing Address - Country:US
Mailing Address - Phone:360-423-0203
Mailing Address - Fax:360-577-0187
Practice Address - Street 1:7017 NE HIGHWAY 99 STE 114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0554
Practice Address - Country:US
Practice Address - Phone:360-694-7484
Practice Address - Fax:360-694-7479
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)