Provider Demographics
NPI:1851658405
Name:ESSEX, SAMUEL BRYAN
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BRYAN
Last Name:ESSEX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 CHARLESTON LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7242
Mailing Address - Country:US
Mailing Address - Phone:409-790-1609
Mailing Address - Fax:
Practice Address - Street 1:5545 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7077
Practice Address - Country:US
Practice Address - Phone:409-790-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)