Provider Demographics
NPI:1598093601
Name:SAMFORD, BRIAN ALLEN (PHD, LMFT, LCDC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLEN
Last Name:SAMFORD
Suffix:
Gender:M
Credentials:PHD, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8910 N LOOP 1604 W APT 1215
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2592
Mailing Address - Country:US
Mailing Address - Phone:210-237-7163
Mailing Address - Fax:
Practice Address - Street 1:8000 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3802
Practice Address - Country:US
Practice Address - Phone:210-237-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7833101YA0400X
TX4940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)