MEDICARE: SAMANTHA FOULKROD M.ED, LPC-S

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	101YM0800X	Mental Health Counselor	77309	TX
2	101YP2500X	Professional Counselor	77309	TX

General Provider Information

NPI Number	:	1942777263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA FOULKROD M.ED, LPC-S

Provider Business Mailing Address
First Line	:	8102 FRY RD STE A
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-7077
Country	:	US
Telephone Number	:	832-725-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	12915 DEER COVE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-4274
Country	:	US
Telephone Number	:	832-725-7619
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	03/21/2025

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