Healthcare Provider Details

I. General information

NPI: 1902034358
Provider Name (Legal Business Name): ELIA SIMON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S. FOREST AVENUE SUITE 334
TEMPE AZ
85287
US

IV. Provider business mailing address

PO BOX 3242
TEMPE AZ
85280-3242
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-6146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-14199
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: