Provider Demographics
NPI:1164076204
Name:DR. LEAH B. SAMLER, LLC
Entity Type:Organization
Organization Name:DR. LEAH B. SAMLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAMLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-297-5561
Mailing Address - Street 1:2147 N HUMBOLDT BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1392
Mailing Address - Country:US
Mailing Address - Phone:773-297-5561
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 635
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3455
Practice Address - Country:US
Practice Address - Phone:773-482-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)