1902104490 NPI number — SAMUELS MEDICAL LLC

Table of content: MRS. ELIZABETH JOY CHARD HORTON MA, NCC, LPC (NPI 1215718507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902104490 NPI number — SAMUELS MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUELS MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902104490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14516 N QUIET RAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORO VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85755-4774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-991-3329
Provider Business Mailing Address Fax Number:
520-382-5928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14516 N QUIET RAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85755-4774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-991-3329
Provider Business Practice Location Address Fax Number:
520-382-5928
Provider Enumeration Date:
03/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMUELS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-991-3329

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)