MEDICARE: SAMARITAN COUNSELING CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1043998180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	202 E BEELINE LN
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1910
Country	:	US
Telephone Number	:	254-279-4305
Fax Number	:	254-218-5532

Provider Business Practice Location Address
First Line	:	202 E BEELINE LN
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1910
Country	:	US
Telephone Number	:	254-279-4305
Fax Number	:	254-231-4944

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	AMIRAH SALDIVAR SMITH
Credential	:	LPC-S, LCDC
Telephone Number	:	254-238-9057

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	12/20/2023

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