Healthcare Provider Details

I. General information

NPI: 1881129328
Provider Name (Legal Business Name): SAMARITAN CENTER FOR COUNSELING AND PASTORAL CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8956 RESEARCH BLVD BLDG 2
AUSTIN TX
78758-5902
US

IV. Provider business mailing address

8956 RESEARCH BLVD BLDG 2
AUSTIN TX
78758-5902
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-7337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number644700
License Number StateTX

VIII. Authorized Official

Name: MICHELLE GERBOZY
Title or Position: OWNER
Credential: LCSW
Phone: 808-366-5414