Provider Demographics
NPI:1548929698
Name:SIMON, KATIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 S BERNARD RD
Mailing Address - Street 2:SUITE A PMB 1006
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518
Mailing Address - Country:US
Mailing Address - Phone:337-306-4540
Mailing Address - Fax:
Practice Address - Street 1:1137 S BERNARD RD
Practice Address - Street 2:SUITE A PMB 1006
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518
Practice Address - Country:US
Practice Address - Phone:337-306-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA140831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14083OtherLICENSE NUMBER