Provider Demographics
NPI:1134644701
Name:SAMET, STEPHEN ELLIOTT
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ELLIOTT
Last Name:SAMET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3584
Mailing Address - Country:US
Mailing Address - Phone:210-736-1762
Mailing Address - Fax:210-736-3156
Practice Address - Street 1:2515 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3584
Practice Address - Country:US
Practice Address - Phone:210-736-1762
Practice Address - Fax:210-736-3156
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty