Nikisha Lynnette Simmons-Maclin, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304191 Issued in MN

Practice address

10026 University Ave NW Ste 103
Coon Rapids, MN 55448-2213

Phone

(612) 636-9677

NPI assigned

Feb 6, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renewed Life Counseling, LLC

  • Substance Abuse Rehabilitation Facility
  • Coon Rapids, MN
  • NPI 1811452188

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1063870905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10732 ILEX ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554486508",
            "telephone_number": "612-636-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10026 UNIVERSITY AVE NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482213",
            "telephone_number": "612-636-9677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8557 Wyoming Ave N Ste 6",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Park",
            "state": "MN",
            "postal_code": "554451847",
            "country_code": "US",
            "telephone_number": "612-636-9677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMMONS-MACLIN",
        "first_name": "NIKISHA",
        "middle_name": "LYNNETTE",
        "name_prefix": "Mrs.",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-06",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA DEPARTMENT OF HUMAN SERVICES",
            "identifier": "1098948",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BOARD OF BEHAVIOR HEALTH",
            "identifier": "304191",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea M. Sieberlich, ST
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• Kristin Sierra, LICSW
• Sarah E Sievert, PT
• Simbal Healthcare Services Inc
• Samantha Marie Simon
• Jennifer Simper
• Sincere Home Care, LLC
• Saul S Singh, DO
• Ayusa Sinha

• Addiction (Substance Use Disorder) Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.