Provider Demographics
NPI:1033293485
Name:LONDE, MICHAEL SIMON (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SIMON
Last Name:LONDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 E 32ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3968
Mailing Address - Country:US
Mailing Address - Phone:417-781-2868
Mailing Address - Fax:417-781-1922
Practice Address - Street 1:712 E 32ND ST STE 1
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3968
Practice Address - Country:US
Practice Address - Phone:417-781-2868
Practice Address - Fax:417-781-1922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1175101YA0400X
OK437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)