Healthcare Provider Details

I. General information

NPI: 1669010179
Provider Name (Legal Business Name): SAMANTHA SYMONS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 HEARN ST STE 100
AUSTIN TX
78703-4516
US

IV. Provider business mailing address

510 HEARN ST STE 100
AUSTIN TX
78703-4516
US

V. Phone/Fax

Practice location:
  • Phone: 512-521-0868
  • Fax:
Mailing address:
  • Phone: 512-521-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMANTHA SYMONS
Title or Position: OWNER
Credential: MD
Phone: 512-585-1217