Provider Demographics
NPI:1245987007
Name:PENA, SAMANTHA (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 SANTA ROSITA DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3411
Mailing Address - Country:US
Mailing Address - Phone:512-763-2186
Mailing Address - Fax:512-727-6364
Practice Address - Street 1:1821 WESTINGHOUSE RD STE 1150
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7645
Practice Address - Country:US
Practice Address - Phone:512-763-2186
Practice Address - Fax:512-727-6364
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist