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General NPI Number Information
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NPI Number | 1558234039
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Entity Type | Individual
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Provider Name | SAMUEL GOLLUB LMFT-ASSOCIATE
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Gender | Male
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 810 W 45TH ST
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City | AUSTIN
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State | TX
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Zip | 78751-2802
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Country | US
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Telephone | 339-927-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 1183 HARGRAVE ST # A
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City | AUSTIN
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State | TX
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Zip | 78702-2423
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 205789
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License Number State | TX
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