Provider Demographics
NPI:1508116401
Name:CUELLAR, SAMANTHA DELIA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DELIA
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PASEO FELIZ DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5687
Mailing Address - Country:US
Mailing Address - Phone:915-588-0761
Mailing Address - Fax:
Practice Address - Street 1:8500 BOEING DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1224
Practice Address - Country:US
Practice Address - Phone:915-599-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health