Provider Demographics
NPI:1992939532
Name:PATEL, SAMIR H
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:H
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 HIGHWAY 121 BYP N STE I
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8864
Mailing Address - Country:US
Mailing Address - Phone:270-761-5804
Mailing Address - Fax:
Practice Address - Street 1:1712 HIGHWAY 121 BYP N STE I
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-761-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH4756101YM0800X
KY173147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY173147OtherKENTUCKY STATE BOARD OF LICENSED PROFESSIONAL COUNSELORS