Provider Demographics
NPI:1881771426
Name:SIMON, SONIA L (CP)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:L
Last Name:SIMON
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2900
Mailing Address - Country:US
Mailing Address - Phone:713-669-1878
Mailing Address - Fax:713-669-9079
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:SUITE 508
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-669-1878
Practice Address - Fax:713-669-9079
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31145103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBC/BSOther0037LV
TX040884103Medicaid
TXBC/BSOther0037LV