Provider Demographics
NPI:1578337069
Name:CLEMENTS, SAMANTHA WENZEL (MA, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:WENZEL
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MA, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ELDER WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7114
Mailing Address - Country:US
Mailing Address - Phone:512-888-6961
Mailing Address - Fax:
Practice Address - Street 1:8700 MENCHACA RD STE 704
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5378
Practice Address - Country:US
Practice Address - Phone:737-297-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health