=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497975999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMUELS PSYCHIATRIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4550 POST OAK PLACE DR SUITE 248
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-627-9400
-----------------------------------------------------
Fax | 713-627-9402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4550 POST OAK PLACE DR SUITE 248
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77027-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-627-9400
-----------------------------------------------------
Fax | 713-627-9402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KAREN VENEGAS SAMUELS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 713-627-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | G7959
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------