Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003193657 |
---|---|
Provider Name | William Simon |
First Address | Medford, OR 97504-4004 |
Second Address | North Bend, OR 97459-3657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2011 |
Last Update Date | 20/10/2016 |