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NPI Code Detail

MEDICARE: SAMANTHA OUK SAM BCBA

MEDICARE: SAMANTHA OUK SAM BCBA
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
1103K00000XBehavior Analyst1-24-77765TX
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1528653193
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA OUK SAM BCBA
Provider Business Mailing Address
First Line : 6421 CAMP BOWIE BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5419
Country : US
Telephone Number : 817-353-2090
Fax Number :
Provider Business Practice Location Address
First Line : 6421 CAMP BOWIE BLVD STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-5419
Country : US
Telephone Number : 817-353-2090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2021
Last Update Date : 11/27/2024

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Directions to “ SAMANTHA OUK SAM BCBA” Practice Location

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