Provider Demographics
NPI:1346461951
Name:SIMON, ELLEN CHERNOFF (LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHERNOFF
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 1:7201 CUTTER MILL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-880-0102
Mailing Address - Fax:888-559-3543
Practice Address - Street 1:17304 PRESTON RD
Practice Address - Street 2:#800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5618
Practice Address - Country:US
Practice Address - Phone:972-880-0102
Practice Address - Fax:888-559-3543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14751OtherLPC