Provider Demographics
NPI:1174066997
Name:SIMON, SAMANTHA E (MA, LPCC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 HUDSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4454
Mailing Address - Country:US
Mailing Address - Phone:952-460-9053
Mailing Address - Fax:651-714-9029
Practice Address - Street 1:6063 HUDSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4454
Practice Address - Country:US
Practice Address - Phone:952-460-9053
Practice Address - Fax:651-714-9029
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional