Provider Demographics
NPI:1114919883
Name:NORMAN, ED.D., SAM R (LPC)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:R
Last Name:NORMAN, ED.D.
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 S KENTUCKY ST
Mailing Address - Street 2:SUITE 125A
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2252
Mailing Address - Country:US
Mailing Address - Phone:806-463-7001
Mailing Address - Fax:806-463-7006
Practice Address - Street 1:1616 S KENTUCKY ST
Practice Address - Street 2:SUITE 125A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2252
Practice Address - Country:US
Practice Address - Phone:806-463-7001
Practice Address - Fax:806-463-7006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TX6087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3620LCOtherBC/BS OF TEXAS