Basic Information
| Provider Information | |||||||||
| NPI: | 1255400859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DWYER | ||||||||
| FirstName: | SIMON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11059 E BETHANY DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800142637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172300 | ||||||||
| FaxNumber: | 3036172397 | ||||||||
| Practice Location | |||||||||
| Address1: | 10782 E ALAMEDA AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800121017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036172651 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3745 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.