Provider Demographics
NPI:1629527619
Name:SAMUELS, TAHIRAH (LCSW-S)
Entity Type:Individual
Prefix:MS
First Name:TAHIRAH
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 JEFFERSON POINT DR
Mailing Address - Street 2:APT 647
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6907
Mailing Address - Country:US
Mailing Address - Phone:817-919-1603
Mailing Address - Fax:682-252-7137
Practice Address - Street 1:2080 N HWY 360 STE 220
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1400
Practice Address - Country:US
Practice Address - Phone:817-919-1603
Practice Address - Fax:682-252-7137
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical