Healthcare Provider Details

I. General information

NPI: 1326009754
Provider Name (Legal Business Name): SAMARITAN COUNSELING CENTER OF SOUTHEAST TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 ROOSEVELT DR
SILSBEE TX
77656-3309
US

IV. Provider business mailing address

3747 DOCTORS DR
PORT ARTHUR TX
77642-5555
US

V. Phone/Fax

Practice location:
  • Phone: 877-385-3347
  • Fax: 409-983-4761
Mailing address:
  • Phone: 409-983-7668
  • Fax: 409-983-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17005
License Number StateTX

VIII. Authorized Official

Name: KRISTI VANN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 409-983-7668