Provider Demographics
NPI:1194382671
Name:SAMUEL, CHIFFON MELISSA (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHIFFON
Middle Name:MELISSA
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S GRANT ST UNIT 14
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2514
Mailing Address - Country:US
Mailing Address - Phone:808-285-9760
Mailing Address - Fax:
Practice Address - Street 1:705 S GRANT ST UNIT 14
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2514
Practice Address - Country:US
Practice Address - Phone:808-285-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health