Provider Demographics
NPI:1922374453
Name:SIMON, S(SUSAN) GAIL (LPC)
Entity Type:Individual
Prefix:
First Name:S(SUSAN)
Middle Name:GAIL
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:RASBAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2465 S DOWNING ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-765-6963
Mailing Address - Fax:303-778-2463
Practice Address - Street 1:2465 DOWNING ST STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-765-6963
Practice Address - Fax:303-778-2463
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12256780OtherCAQH