Basic Information
| Provider Information | |||||||||
| NPI: | 1306401666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEVELL | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | JO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 SAN FELIPE ST STE 990 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770631708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818263382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2620 FORUM BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735148735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.