Provider Demographics
NPI:1609344928
Name:SIMOSON, STEPHEN HAROLD (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HAROLD
Last Name:SIMOSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27040 E US HIGHWAY 380 APT 10207
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1566
Mailing Address - Country:US
Mailing Address - Phone:940-391-6890
Mailing Address - Fax:
Practice Address - Street 1:4020 HUFFINES BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6524
Practice Address - Country:US
Practice Address - Phone:940-391-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77904OtherLPC