Basic Information
| Provider Information | |||||||||
| NPI: | 1720352669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMO | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2173 N RIDGE RD E | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440553400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402606108 | ||||||||
| FaxNumber: | 4402823400 | ||||||||
| Practice Location | |||||||||
| Address1: | 2173 N RIDGE RD E | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440553400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402606108 | ||||||||
| FaxNumber: | 4402823400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2012 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.0602042 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | E.0602042-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.