Provider Demographics
NPI:1457909905
Name:BORE, SAMUEL K (LPC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:K
Last Name:BORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3587
Mailing Address - Country:US
Mailing Address - Phone:469-835-2904
Mailing Address - Fax:
Practice Address - Street 1:4683 BETTS DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1801
Practice Address - Country:US
Practice Address - Phone:469-835-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health