Provider Demographics
NPI:1962028381
Name:WEGMAN, SAM (MS, LPCP INTERN)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:WEGMAN
Suffix:
Gender:M
Credentials:MS, LPCP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5857
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5857
Mailing Address - Country:US
Mailing Address - Phone:832-233-3086
Mailing Address - Fax:832-415-3050
Practice Address - Street 1:20031 W LAKE HOUSTON PKWY STE 400
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3462
Practice Address - Country:US
Practice Address - Phone:832-233-3086
Practice Address - Fax:832-415-3050
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83485OtherLPC-IINTERN