Samantha Ann Simmons, LPCC, LCADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

834 Issued in KY

Practice address

80 Rolling Hills Blvd
Monticello, KY 42633-9005

Phone

(066) 343-0216

Fax

(606) 343-0224

NPI assigned

Jan 23, 2007

Last updated

Oct 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Samantha Ann Roberts Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Foothills Academy, Inc.

  dba Community Based Interventions

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Monticello, KY
  • NPI 1114291879
  Medicare reassignment NPD Authorized official
• Foothills Academy, Inc

  dba Community Based Interventions

  • Multi-Specialty Clinic/Center
  • Monticello, KY
  • NPI 1306250782

  Professional

  NPD Authorized official
• Foothills Recovery

  • Substance Abuse Rehabilitation Facility
  • Albany, KY
  • NPI 1578396305
  NPD Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1629123625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 ROLLING HILLS BLVD",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426339005",
            "telephone_number": "606-343-0216",
            "fax_number": "066-343-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 ROLLING HILLS BLVD",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426339005",
            "telephone_number": "066-343-0216",
            "fax_number": "606-343-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "SAMANTHA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LPCC, LCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "166494",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "105683",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100277600",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30615058",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "ROBERTS",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Monticello, KY
• Providers in Monticello, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.