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General NPI Number Information
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NPI Number | 1174066997
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Entity Type | Individual
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Provider Name | SAMANTHA E SIMON MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 6063 HUDSON RD SUITE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4454
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Country | US
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Telephone | 952-460-9053
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Fax | 651-714-9029
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Provider Business Mailing Address
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Address Line | 6063 HUDSON RD SUITE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4454
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Country | US
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Telephone | 952-460-9053
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Fax | 651-714-9029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC01336
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License Number State | MN
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