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NPI Code Detail

MEDICARE: SAMANTHA DELIA CUELLAR LPC, NCC

MEDICARE: SAMANTHA DELIA CUELLAR LPC, NCC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor65067TX

General Provider Information

NPI Number : 1508116401
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DELIA CUELLAR LPC, NCC
Provider Business Mailing Address
First Line : 1551 PASEO FELIZ DR
Second Line :
City : EL PASO
State : TX
Zip : 79928-5687
Country : US
Telephone Number : 915-588-0761
Fax Number :
Provider Business Practice Location Address
First Line : 8500 BOEING DR
Second Line :
City : EL PASO
State : TX
Zip : 79925-1224
Country : US
Telephone Number : 915-599-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2012
Last Update Date : 09/18/2012

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