Provider Demographics
NPI:1174881783
Name:SAMSEL, ROBERT M (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:SAMSEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:MICHAEL
Other - Last Name:SAMSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 2603
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-335-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2020-09-10
Deactivation Date:2019-07-09
Deactivation Code:
Reactivation Date:2020-08-25
Provider Licenses
StateLicense IDTaxonomies
TX65027101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health