Provider Demographics
NPI:1215719828
Name:ANDERSON SCHELLING, SIMON MICAH (MSW, LSW)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:MICAH
Last Name:ANDERSON SCHELLING
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 EASTPORT CENTRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4456
Mailing Address - Country:US
Mailing Address - Phone:219-286-6482
Mailing Address - Fax:219-286-7367
Practice Address - Street 1:954 EASTPORT CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4456
Practice Address - Country:US
Practice Address - Phone:219-286-6482
Practice Address - Fax:219-286-7367
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99121217A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker