Provider Demographics
NPI:1972186120
Name:KBOUDI, SIMONE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:KBOUDI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 BURTON WAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1618
Mailing Address - Country:US
Mailing Address - Phone:888-494-7788
Mailing Address - Fax:
Practice Address - Street 1:9014 BURTON WAY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1618
Practice Address - Country:US
Practice Address - Phone:888-494-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor