Provider Demographics
NPI:1386155976
Name:SIMON, JENA M (MA)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:M
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:M
Other - Last Name:DETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8500 N MOPAC EXPY STE 402
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8347
Mailing Address - Country:US
Mailing Address - Phone:512-783-8382
Mailing Address - Fax:512-535-3499
Practice Address - Street 1:1165 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3152
Practice Address - Country:US
Practice Address - Phone:512-439-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional