Provider Demographics
NPI:1972330090
Name:SIMONTON, ELASHA (MS, LPC)
Entity type:Individual
Prefix:
First Name:ELASHA
Middle Name:
Last Name:SIMONTON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8042
Mailing Address - Country:US
Mailing Address - Phone:817-522-2566
Mailing Address - Fax:
Practice Address - Street 1:4120 SHANNON DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-8042
Practice Address - Country:US
Practice Address - Phone:817-522-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional