Provider Demographics
NPI:1841392727
Name:SAMARITAN COUNSELING CENTER OF EAST TX, INC
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF EAST TX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-564-4064
Mailing Address - Street 1:903 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4479
Mailing Address - Country:US
Mailing Address - Phone:936-564-4064
Mailing Address - Fax:936-564-1570
Practice Address - Street 1:903 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4479
Practice Address - Country:US
Practice Address - Phone:936-564-4064
Practice Address - Fax:936-564-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U07POtherBLUE CROSS/BLUE SHIELD