Provider Demographics
NPI:1073831277
Name:SIMON, MINDON LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MINDON
Middle Name:LEE
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MINDON
Other - Middle Name:LEE
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2900 S STATE ST
Mailing Address - Street 2:#101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3880
Mailing Address - Country:US
Mailing Address - Phone:801-983-5540
Mailing Address - Fax:801-983-5542
Practice Address - Street 1:3195 S MAIN ST STE 180
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3790
Practice Address - Country:US
Practice Address - Phone:801-983-5540
Practice Address - Fax:801-983-5542
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT291842-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker