Provider Demographics
NPI:1790752319
Name:FOGLE, SAMUEL PATRICK (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:PATRICK
Last Name:FOGLE
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 E SOUTH 11TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4283
Mailing Address - Country:US
Mailing Address - Phone:325-676-2039
Mailing Address - Fax:325-480-4784
Practice Address - Street 1:1219 E SOUTH 11TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4283
Practice Address - Country:US
Practice Address - Phone:325-676-2039
Practice Address - Fax:325-480-4784
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16245101YP2500X, 101YA0400X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7252LCOtherBLUE CROSS & BLUE SHIELD