Provider Demographics
NPI:1124492533
Name:SAMUEL-KOSHY, RACHEL LISA (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LISA
Last Name:SAMUEL-KOSHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LISA
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:24646 KINGSLAND BLVD.
Mailing Address - Street 2:CINCO RANCH BEHAVIORAL HEALTH
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494
Mailing Address - Country:US
Mailing Address - Phone:281-665-7346
Mailing Address - Fax:281-674-8422
Practice Address - Street 1:24646 KINGSLAND BLVD.
Practice Address - Street 2:CINCO RANCH BEHAVIORAL HEALTH
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494
Practice Address - Country:US
Practice Address - Phone:281-665-7346
Practice Address - Fax:281-674-8422
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical