Provider Demographics
NPI:1164716882
Name:SIMON, ROSE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 BEECHNUT ST APT 304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5019
Mailing Address - Country:US
Mailing Address - Phone:281-575-1258
Mailing Address - Fax:
Practice Address - Street 1:10215 BEECHNUT ST APT 304
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5019
Practice Address - Country:US
Practice Address - Phone:281-575-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204628601Medicaid