Provider Demographics
NPI:1356655112
Name:SAMANTHA SIEGEL, LPC
Entity Type:Organization
Organization Name:SAMANTHA SIEGEL, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:BRYN
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MED
Authorized Official - Phone:972-400-0487
Mailing Address - Street 1:5209 HERITAGE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5987
Mailing Address - Country:US
Mailing Address - Phone:817-545-7100
Mailing Address - Fax:817-545-4555
Practice Address - Street 1:5209 HERITAGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5987
Practice Address - Country:US
Practice Address - Phone:817-545-7100
Practice Address - Fax:817-545-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63713251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health