Healthcare Provider Details

I. General information

NPI: 1972573996
Provider Name (Legal Business Name): SARA SIMON PH.D., LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

11313 CONSTITUTION AVE NE
ALBUQUERQUE NM
87112-5545
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2190
  • Fax: 505-272-3466
Mailing address:
  • Phone: 505-293-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2156
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: