Provider Demographics
NPI:1659907384
Name:ESPINOZA, SAMANTHA (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 COUNTY ROAD 2620
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-7331
Mailing Address - Country:US
Mailing Address - Phone:214-326-4479
Mailing Address - Fax:
Practice Address - Street 1:303 TX-78
Practice Address - Street 2:#100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75088
Practice Address - Country:US
Practice Address - Phone:469-342-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor