Basic Information
| Provider Information | |||||||||
| NPI: | 1508050444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAZIER | ||||||||
| FirstName: | SAMILLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, LPC, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4625 NORTH FWY | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770222914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136970776 | ||||||||
| FaxNumber: | 7136972309 | ||||||||
| Practice Location | |||||||||
| Address1: | 4625 NORTH FWY | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770222914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136970776 | ||||||||
| FaxNumber: | 7136972309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 09/04/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 9626 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 20226 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.