Provider Demographics
NPI:1871134247
Name:GOSS, SAMANTHA (MS, LCDC, LPC-I)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:MS, LCDC, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W EUBANK ST
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-8318
Mailing Address - Country:US
Mailing Address - Phone:903-910-9540
Mailing Address - Fax:
Practice Address - Street 1:219 W EUBANK ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8318
Practice Address - Country:US
Practice Address - Phone:903-910-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13440101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty