Provider Demographics
NPI:1518795780
Name:LEDEZMA, SAMANTHA (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 ATASCOCITA VALE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-5084
Mailing Address - Country:US
Mailing Address - Phone:832-609-0250
Mailing Address - Fax:
Practice Address - Street 1:700 ROCKMEAD DR STE 200
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5018
Practice Address - Country:US
Practice Address - Phone:281-594-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health