MEDICARE: TINITA ESTELLE SAMUELS LCSW

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	1041C0700X	Clinical Social Worker	108393	TX

General Provider Information

NPI Number	:	1578372306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINITA ESTELLE SAMUELS LCSW

Provider Business Mailing Address
First Line	:	23400 KINGSLAND BLVD APT 9208
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7484
Country	:	US
Telephone Number	:	562-584-3284
Fax Number	:	832-431-4247

Provider Business Practice Location Address
First Line	:	23400 KINGSLAND BLVD APT 9208
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7484
Country	:	US
Telephone Number	:	562-584-3284
Fax Number	:	832-431-4246

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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