Provider Demographics
NPI:1780706622
Name:SIMMONS, LORI BETH (LMFT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:BETH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 HIGHLAND FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1065
Mailing Address - Country:US
Mailing Address - Phone:408-307-9879
Mailing Address - Fax:408-307-9879
Practice Address - Street 1:630 HIGHLAND FARMS CIR
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1065
Practice Address - Country:US
Practice Address - Phone:408-307-9879
Practice Address - Fax:408-307-9879
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAMFC 48744106H00000X
MDLCM418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
3347Medicare UPIN