Provider Demographics
NPI:1295728657
Name:SIMON, CHRISTINE R (MS, LPC, LPA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS, LPC, LPA
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 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:402 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-5215
Practice Address - Country:US
Practice Address - Phone:254-718-3887
Practice Address - Fax:254-634-7531
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156595403Medicaid