Provider Demographics
NPI:1124741384
Name:STAYTON, SAMANTHA (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STAYTON
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E 39TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2692
Mailing Address - Country:US
Mailing Address - Phone:816-830-0268
Mailing Address - Fax:
Practice Address - Street 1:6155 OAK ST STE C
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2266
Practice Address - Country:US
Practice Address - Phone:816-226-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS055821041C0700X
MO20210318531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical