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General NPI Number Information
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NPI Number | 1275173536
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Entity Type | Individual
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Provider Name | SAMUEL A WOLDE
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 4635 SOUTHWEST FWY STE 635
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City | HOUSTON
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State | TX
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Zip | 77027-7112
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Country | US
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Telephone | 713-850-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 10428 W COLTER ST
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City | GLENDALE
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State | AZ
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Zip | 85307-4195
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Country | US
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Telephone | 720-226-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 18390
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 39274
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License Number State | TX
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