MEDICARE: SUZANNE R SIMON LPC

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	101YP2500X	Professional Counselor	4575	LA
2	101YM0800X	Mental Health Counselor	4575	LA

General Provider Information

NPI Number	:	1457853699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE R SIMON LPC

Provider Business Mailing Address
First Line	:	1115 WEBER ST
Second Line	:
City	:	FRANKLIN
State	:	LA
Zip	:	70538-4124
Country	:	US
Telephone Number	:	337-828-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 MAGNOLIA ST
Second Line	:
City	:	HOUMA
State	:	LA
Zip	:	70360-6377
Country	:	US
Telephone Number	:	985-850-9517
Fax Number	:

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

Provider Enumeration Date	:	03/04/2018
Last Update Date	:	06/17/2022

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