Provider Demographics
NPI:1255588372
Name:SIMON, JEREMI D (BHS)
Entity type:Individual
Prefix:
First Name:JEREMI
Middle Name:D
Last Name:SIMON
Suffix:
Gender:M
Credentials:BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1737
Mailing Address - Country:US
Mailing Address - Phone:270-901-5000
Mailing Address - Fax:
Practice Address - Street 1:501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1737
Practice Address - Country:US
Practice Address - Phone:270-901-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid