Provider Demographics
NPI:1225454119
Name:GEORGE K. SIMON, JR., PHD, PA
Entity Type:Organization
Organization Name:GEORGE K. SIMON, JR., PHD, PA
Other - Org Name:CHERYL L. SIMON, PHD, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-663-5075
Mailing Address - Street 1:415 N MCKINLEY ST
Mailing Address - Street 2:#1040
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3013
Mailing Address - Country:US
Mailing Address - Phone:501-663-5075
Mailing Address - Fax:501-224-2680
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:#1040
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-663-5075
Practice Address - Fax:501-224-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR86-19P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59126Medicare UPIN