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NPI Code Detail

MEDICARE: SAMANTHA SAWYER GIBSON LPC-I, NCC

MEDICARE: SAMANTHA SAWYER GIBSON LPC-I, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor84614TX

General Provider Information

NPI Number : 1053910109
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA SAWYER GIBSON LPC-I, NCC
Provider Business Mailing Address
First Line : 5910 N CENTRAL EXPY STE 1820
Second Line :
City : DALLAS
State : TX
Zip : 75206-0946
Country : US
Telephone Number : 214-363-2345
Fax Number : 469-716-5053
Provider Business Practice Location Address
First Line : 5910 N CENTRAL EXPY STE 1820
Second Line :
City : DALLAS
State : TX
Zip : 75206-0946
Country : US
Telephone Number : 214-363-2345
Fax Number : 469-716-5053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2020
Last Update Date : 10/20/2020

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