Basic Information
| Provider Information | |||||||||
| NPI: | 1881129328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMARITAN CENTER FOR COUNSELING AND PASTORAL CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8956 RESEARCH BLVD | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585902 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 8956 RESEARCH BLVD | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124517337 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2017 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | GERBOZY | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8083665414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 644700 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.