Basic Information
| Provider Information | |||||||||
| NPI: | 1245987007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2904 SANTA ROSITA DR | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786653411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127632186 | ||||||||
| FaxNumber: | 5127276364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1821 WESTINGHOUSE RD STE 1150 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786267645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127632186 | ||||||||
| FaxNumber: | 5127276364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 203785 | TX | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.