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General NPI Number Information
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NPI Number | 1649034562
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Entity Type | Organization
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Legal Business Name | SAMARA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 10521 W FOREST HOME AVE STE 301
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City | HALES CORNERS
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State | WI
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Zip | 53130-2063
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Country | US
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Telephone | 414-293-2493
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Fax |
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Provider Business Mailing Address
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Address Line | 10521 W FOREST HOME AVE STE 301
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City | HALES CORNERS
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State | WI
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Zip | 53130-2063
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Country | US
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Telephone | 414-293-2493
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST / OWNER
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Name | ANNE DAVID
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Credential | LCSW
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Telephone | 414-232-8606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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