Healthcare Provider Details

I. General information

NPI: 1801575808
Provider Name (Legal Business Name): TRACIE RANAE SIMON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S WALNUT AVE STE 140
AMES IA
50010-6974
US

IV. Provider business mailing address

5408 NW 88TH ST STE 140
JOHNSTON IA
50131-2953
US

V. Phone/Fax

Practice location:
  • Phone: 515-368-7504
  • Fax: 515-355-3491
Mailing address:
  • Phone: 515-368-7504
  • Fax: 515-355-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number119830
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: