Provider Demographics
NPI:1427204320
Name:DWYER SIMONSEN, MOLLY (LPC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DWYER SIMONSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:COLLEEN
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1711 WINESAP LN
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2247
Mailing Address - Country:US
Mailing Address - Phone:314-821-2686
Mailing Address - Fax:
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-776-7990
Practice Address - Fax:314-772-2257
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health