Provider Demographics
NPI:1962959841
Name:DELOACH, SIMONE (MFT, LCDC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:DELOACH
Suffix:
Gender:F
Credentials:MFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S HARRIS ST STE 230
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6081
Mailing Address - Country:US
Mailing Address - Phone:512-843-3130
Mailing Address - Fax:
Practice Address - Street 1:106 S HARRIS ST STE 230
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6081
Practice Address - Country:US
Practice Address - Phone:512-843-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2025-11-20
Deactivation Date:2025-09-23
Deactivation Code:
Reactivation Date:2025-11-20
Provider Licenses
StateLicense IDTaxonomies
TX204827101YM0800X
222Q00000X
TX16134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)