Provider Demographics
NPI:1437045028
Name:ESPINOSA, SAMANTHA MARIE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 SABOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310
Mailing Address - Country:US
Mailing Address - Phone:940-337-0489
Mailing Address - Fax:
Practice Address - Street 1:5816 ASHLEYANNE CIRCLE
Practice Address - Street 2:SUITE 400
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310
Practice Address - Country:US
Practice Address - Phone:940-757-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25425716106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician