Healthcare Provider Details

I. General information

NPI: 1457853699
Provider Name (Legal Business Name): SUZANNE R SIMON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAGNOLIA ST
HOUMA LA
70360-6377
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 985-850-9517
  • Fax:
Mailing address:
  • Phone: 337-828-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4575
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4575
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: