Individual
JEREMY SCOTT SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LCDC, LPC-I
Contact information
Practice address
756 PURPLE SAGE RD, BANDERA, TX 78003
(844) 448-2567
Mailing address
PO BOX 1503, FREDERICKSBURG, TX 78624-1503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14709
TX
101YM0800X
Mental Health Counselor
80898
TX
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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