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General NPI Number Information
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NPI Number | 1588437834
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Entity Type | Individual
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Provider Name | JENNIFER SAMUEL LPC
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST STE 450
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City | FORT WORTH
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State | TX
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Zip | 76109-4910
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Country | US
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Telephone | 817-374-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 1877 PARK ST
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City | AZLE
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State | TX
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Zip | 76020-3743
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Country | US
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Telephone | 817-374-4401
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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 | 82913
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License Number State | TX
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