Stacey Simon, LPCC-S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.1700029-SUPV Issued in OH

Practice address

204 W Wayne St Ste 210-7
Maumee, OH 43537-2125

Phone

(419) 359-8600

NPI assigned

Jan 12, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Perrysburg Therapy LLC

  • Clinical Social Worker
  • Perrysburg, OH
  • NPI 1073054219

  Mental Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1336538545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 CHESTERFIELD LN",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372212",
            "telephone_number": "419-704-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W WAYNE ST STE 210-7",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435372125",
            "telephone_number": "419-359-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 W South Boundary St",
            "address_purpose": "LOCATION",
            "city": "Perrysburg",
            "state": "OH",
            "postal_code": "435515238",
            "country_code": "US",
            "telephone_number": "419-931-3020",
            "fax_number": "419-931-3022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "STACEY",
        "credential": "LPCC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-12",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1700029",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1700029-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Ann Shidler
• Catherine Shubert
• Katelyn Siebarth, RBT
• Donald Sigman
• Todd Matthew Simmons, MD
• Lakeesha Sims, DNP, MSN-ED RN
• Ajay Singh, DDS
• Ravinder Pal Singh
• Shalini Singh, D.O.
• Michael Skiba

• Mental Health Counselor in Maumee, OH
• Providers in Maumee, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.