Provider Demographics
NPI:1578372306
Name:SAMUELS, TINITA ESTELLE (LCSW)
Entity type:Individual
Prefix:
First Name:TINITA
Middle Name:ESTELLE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23400 KINGSLAND BLVD APT 9208
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7484
Mailing Address - Country:US
Mailing Address - Phone:562-584-3284
Mailing Address - Fax:832-431-4247
Practice Address - Street 1:23400 KINGSLAND BLVD APT 9208
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7484
Practice Address - Country:US
Practice Address - Phone:562-584-3284
Practice Address - Fax:832-431-4246
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty