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General NPI Number Information
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NPI Number | 1881070290
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Entity Type | Organization
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Legal Business Name | DEBORAH SIMONIS LCSW
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 2426 W CORNERSTONE CT
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City | PEORIA
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State | IL
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Zip | 61614-2492
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Country | US
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Telephone | 309-750-2828
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Fax | 309-200-0218
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Provider Business Mailing Address
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Address Line | 517 E BULLOCK ST
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City | EUREKA
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State | IL
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Zip | 61530-1256
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Country | US
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Telephone | 309-750-2828
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Fax | 309-200-0218
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Authorized Official
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Title or Position | CHILD AND FAMILY PSYCHOTHERAPIST
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Name | DEBORAH JEAN SIMONIS-GAYED
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Credential | LCSW, IBECPTS
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Telephone | 309-750-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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