Provider Demographics
NPI:1619078987
Name:SAMUL, ALEXANDER TYTUS (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:TYTUS
Last Name:SAMUL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28804 31 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MI
Mailing Address - Zip Code:48050
Mailing Address - Country:US
Mailing Address - Phone:586-727-3281
Mailing Address - Fax:
Practice Address - Street 1:1007 MILITARY ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-966-2577
Practice Address - Fax:810-987-2336
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker