Provider Demographics
NPI:1548912876
Name:SIMMONS, RIVER
Entity type:Individual
Prefix:
First Name:RIVER
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STRADA DI VILLAGGIO UNIT 308
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2822
Mailing Address - Country:US
Mailing Address - Phone:949-878-0887
Mailing Address - Fax:
Practice Address - Street 1:30 STRADA DI VILLAGGIO UNIT 308
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-2822
Practice Address - Country:US
Practice Address - Phone:949-878-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health