Provider Demographics
NPI:1386237626
Name:SIMON, MELVIN JR (BIS, MED,ADULT ED)
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:SIMON
Suffix:JR
Gender:M
Credentials:BIS, MED,ADULT ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SWEETGUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058
Mailing Address - Country:US
Mailing Address - Phone:504-295-8271
Mailing Address - Fax:
Practice Address - Street 1:3160 SWEETGUM DRIVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-295-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management