Provider Demographics
NPI:1235845629
Name:SIMMONS, BROOKE ALEXIS (BCBA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXIS
Last Name:SIMMONS
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GANTT RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5400
Mailing Address - Country:US
Mailing Address - Phone:470-955-0963
Mailing Address - Fax:
Practice Address - Street 1:1750 BEAVER RUIN RD STE 500
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2813
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst