MEDICARE: SOPHIE SIMON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	NA	CO

General Provider Information

NPI Number	:	1295425254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE SIMON

Provider Business Mailing Address
First Line	:	8372 WILMINGTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7076
Country	:	US
Telephone Number	:	720-317-3238
Fax Number	:

Provider Business Practice Location Address
First Line	:	8372 WILMINGTON DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7076
Country	:	US
Telephone Number	:	720-317-3238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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Directions to “ SOPHIE SIMON ” Practice Location

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