Provider Demographics
NPI:1124239793
Name:SIMON, ROBERT MELVIN JR (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MELVIN
Last Name:SIMON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 MAGNOLIA PINES DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1702
Mailing Address - Country:US
Mailing Address - Phone:281-236-7332
Mailing Address - Fax:
Practice Address - Street 1:4516 MAGNOLIA PINES DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1702
Practice Address - Country:US
Practice Address - Phone:281-236-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor