Doctor Name: | MARY L. SIMBARCELOS |
NPI Number: | 1497053144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LMHP, LADC |
License Number: | 405 |
Business Practice Address: | 24 Country Club Lane Pinedale, WY - 82941 |
Business Phone Number: | 3073672111 |
Business Fax Number: | 3073672166 |
Mailing Address: | 24 Country Club Lane, P. O. Box 856 PINEDALE |
State: | WY |
Postal Code: | 82941 |
Phone Number: | 3073672111 |
Fax Number: | 3073672166 |
NPI Enumeration Date: | 03/04/2011 |
NPI Last Update Date: | 01/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 405 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |