Provider Demographics
NPI:1083858005
Name:SIMON, GEORGE K JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:K
Last Name:SIMON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INNWOOD CIR STE 124
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2448
Mailing Address - Country:US
Mailing Address - Phone:501-258-8326
Mailing Address - Fax:
Practice Address - Street 1:1 INNWOOD CIR STE 124
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2448
Practice Address - Country:US
Practice Address - Phone:501-258-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86-18P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical