Healthcare Provider Details

I. General information

NPI: 1831012640
Provider Name (Legal Business Name): RANDI RENEE SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VENUS DR
LAFAYETTE LA
70501-3118
US

IV. Provider business mailing address

150 VENUS DR
LAFAYETTE LA
70501-3118
US

V. Phone/Fax

Practice location:
  • Phone: 337-654-6648
  • Fax: 337-654-6648
Mailing address:
  • Phone: 337-654-6648
  • Fax: 337-654-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberR-28851
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: