Individual
MRS. ELIZABETH SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAC
Contact information
Practice address
811 W 2ND ST, BLOOMINGTON, IN 47403-2212
(812) 333-4001
Mailing address
3403 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 957-2000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001618A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300050689
—
IN
Enumeration date
10/10/2019
Last updated
11/15/2022
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