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General NPI Number Information
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NPI Number | 1497053144
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Entity Type | Individual
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Provider Name | MARY L. SIMBARCELOS MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2011
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 431 W. PINE ST.
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City | PINEDALE
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State | WY
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Zip | 82941
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Country | US
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Telephone | 402-525-7509
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Fax | 307-367-2864
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Provider Business Mailing Address
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Address Line | PO BOX 1641
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City | PINEDALE
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State | WY
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Zip | 82941-1641
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Country | US
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Telephone | 402-525-7509
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Fax | 307-367-2864
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 405
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 1799
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1381
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License Number State | WY
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