Provider Demographics
NPI:1740011378
Name:SIMON, CARIE LEANNE
Entity type:Individual
Prefix:
First Name:CARIE
Middle Name:LEANNE
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32070 SPRENGER LN
Mailing Address - Street 2:
Mailing Address - City:SHEDD
Mailing Address - State:OR
Mailing Address - Zip Code:97377-9733
Mailing Address - Country:US
Mailing Address - Phone:541-255-6828
Mailing Address - Fax:
Practice Address - Street 1:2727 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5901
Practice Address - Country:US
Practice Address - Phone:541-682-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health