Provider Demographics
NPI:1639579741
Name:SIMON, GALE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4254
Mailing Address - Country:US
Mailing Address - Phone:810-300-3357
Mailing Address - Fax:
Practice Address - Street 1:50630 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-4009
Practice Address - Country:US
Practice Address - Phone:586-949-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007260101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor