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General NPI Number Information
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NPI Number | 1811156573
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Entity Type | Individual
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Provider Name | JUSTIN O SIMONS PCC
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Gender | Male
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 35000 CHARDON RD # 210
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094-9012
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Country | US
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Telephone | 440-951-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 135 BURLINGTON OVAL DR
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City | CHARDON
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State | OH
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Zip | 44024-1453
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Country | US
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Telephone | 440-636-3914
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Fax |
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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 | E 0500992
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License Number State | OH
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