Provider Demographics
NPI:1114356326
Name:SIMON, CANDICE YU (MFTI)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:YU
Last Name:SIMON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 COASTLAND DR
Mailing Address - Street 2:REQ
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3602
Mailing Address - Country:US
Mailing Address - Phone:650-329-1398
Mailing Address - Fax:
Practice Address - Street 1:731 COASTLAND DR
Practice Address - Street 2:REQ
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3602
Practice Address - Country:US
Practice Address - Phone:650-329-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI68272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist