Provider Demographics
NPI:1174799571
Name:SIMON, JULIE M (MA MBA MFT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA MBA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 OVERLAND AVE
Mailing Address - Street 2:SUITE 500A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-281-6028
Mailing Address - Fax:
Practice Address - Street 1:2566 OVERLAND AVE
Practice Address - Street 2:SUITE 500A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3366
Practice Address - Country:US
Practice Address - Phone:310-281-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist