Individual ProviderKhalilah SamuelsCounselorBehavioral Health & Social Service ProvidersPractice Address3845 Telegraph Ave, Oakland, CA 94609-2419(510) 784-5874PECOS EnrollmentBased on the most recent information from CMS, provider Khalilah Samuels does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1275230401Provider TypeIndividualFull NameSamuels, KhalilahGenderFemaleSole ProprietorNoEnumeration Date2/8/2023Last Updated2/8/2023Contact InformationPractice LocationPractice Address3845 Telegraph Ave, Oakland, CA 94609-2419Phone(510) 784-5874FaxUnlisted FaxMailing LocationMailing Address3845 Telegraph Ave, Oakland, CA 94609-2419Phone(510) 784-5874FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCalifornia