MEDICARE: MS. SAMANTHA MARIA AIRHART LPC

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
1	101YP2500X	Professional Counselor	19320	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84908L	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1306872825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA MARIA AIRHART LPC

Provider Business Mailing Address
First Line	:	604 DE LEON AVE
Second Line	:
City	:	RANCHO VIEJO
State	:	TX
Zip	:	78575-9506
Country	:	US
Telephone Number	:	956-455-6200
Fax Number	:	956-289-7257

Provider Business Practice Location Address
First Line	:	7319 NET VALLEY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78242-2048
Country	:	US
Telephone Number	:	956-455-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	05/24/2016

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