Healthcare Provider Details

I. General information

NPI: 1366200081
Provider Name (Legal Business Name): RICHARD DOUGLAS SAMBROOK MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 BEE CAVES RD STE H2
WEST LAKE HILLS TX
78746-5246
US

IV. Provider business mailing address

137 TOMATILLO CV
KYLE TX
78640-5723
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-0551
  • Fax: 512-717-6337
Mailing address:
  • Phone: 860-538-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1153543
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: