Individual
SHANNON SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 N MAIN ST, OPELOUSAS, LA 70570-6256
(337) 942-6400
Mailing address
301 W MARTIN LUTHER KING DR, CHURCH POINT, LA 70525-2506
(281) 299-1383
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC-5164
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/13/2019
Last updated
06/19/2024
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