Provider Demographics
NPI:1124422134
Name:SABUR, SAMIYYAH (LPC-S)
Entity type:Individual
Prefix:
First Name:SAMIYYAH
Middle Name:
Last Name:SABUR
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22273
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-2273
Mailing Address - Country:US
Mailing Address - Phone:346-814-4811
Mailing Address - Fax:
Practice Address - Street 1:712 WILCREST DR STE 2082
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-1348
Practice Address - Country:US
Practice Address - Phone:346-814-4811
Practice Address - Fax:832-201-9827
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC3412101Y00000X
TX72204101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX72204OtherSTATE OF TEXAS
TX72204Medicaid
FLTPMC3412OtherSTATE OF FLORIDA