Provider Demographics
NPI:1821185117
Name:SIMON, BETH S (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:S
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD
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 150
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93421
Mailing Address - Country:US
Mailing Address - Phone:805-709-1601
Mailing Address - Fax:760-280-8929
Practice Address - Street 1:1303 E GRAND AVENUE
Practice Address - Street 2:SUITE 201 P
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93421
Practice Address - Country:US
Practice Address - Phone:805-709-1601
Practice Address - Fax:760-280-8929
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17189103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP17189Medicare ID - Type Unspecified