=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831034537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDLY PSYCHOTHERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 SATELLITE VW UNIT 603
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78665-1592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-843-1154
-----------------------------------------------------
Fax | 512-894-6412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 MAIS DR
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-3058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-843-1154
-----------------------------------------------------
Fax | 512-894-6412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | SAMANTHA CANNON ROBERTS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 512-843-1154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------