Provider Demographics
NPI:1649744764
Name:SIMBECK, GWEN EILEEN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:EILEEN
Last Name:SIMBECK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:EILEEN
Other - Last Name:BRAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:17840 GRAMA RDG
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1363
Mailing Address - Country:US
Mailing Address - Phone:719-481-6150
Mailing Address - Fax:
Practice Address - Street 1:244 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9173
Practice Address - Country:US
Practice Address - Phone:719-481-6150
Practice Address - Fax:719-487-3287
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional