Individual
MRS. JACKLYN SAMUELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1925 HAYES AVE, SANDUSKY, OH 44870-4737
(419) 557-5177
Mailing address
675 BARTSON RD, FREMONT, OH 43420-9672
(419) 332-5524
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C.2002650-TRNE
OH
101YM0800X
Mental Health Counselor
Primary
C.2103762
OH
Other
Enumeration date
09/11/2020
Last updated
10/12/2021
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