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General NPI Number Information
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NPI Number | 1558000646
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Entity Type | Individual
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Provider Name | CASSIE JANE SAMUELSON LCDC, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 225 N MICHIGAN AVE STE 1430
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City | CHICAGO
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State | IL
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Zip | 60601-7653
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Country | US
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Telephone | 312-766-6780
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 KNOB HILL RD # 207
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City | AZLE
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State | TX
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Zip | 76020-6801
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Country | US
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Telephone | 254-485-6798
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16327
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88906
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License Number State | TX
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