Provider Demographics
NPI:1497053144
Name:SIMBARCELOS, MARY L (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:SIMBARCELOS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-1641
Mailing Address - Country:US
Mailing Address - Phone:402-525-7509
Mailing Address - Fax:307-367-2864
Practice Address - Street 1:431 W. PINE ST.
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:402-525-7509
Practice Address - Fax:307-367-2864
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE405101YA0400X
NE1799102L00000X
WY1381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE710765000OtherMAGELLAN
NE10025915300Medicaid