=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942679345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMMY ESPINOSA M.S., LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2015
-----------------------------------------------------
Last Update Date | 09/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2402 52ND STREET, SUITE #6
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79412-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-773-7100
-----------------------------------------------------
Fax | 806-797-7101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4216 64TH
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79413-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-773-1966
-----------------------------------------------------
Fax | 806-797-7101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------