Provider Demographics
NPI:1417206236
Name:SIMON, RICHARD E (LCPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:SIMON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 OLD GLENVIEW ROAD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-256-2000
Mailing Address - Fax:847-256-2300
Practice Address - Street 1:3330 OLD GLENVIEW ROAD
Practice Address - Street 2:SUITE 15
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-256-2000
Practice Address - Fax:847-256-2300
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health