Provider Demographics
NPI:1386290864
Name:MOYER, SAMANTHA J (BA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:MOYER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:HARLEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FORTNER
Mailing Address - Street 1:2323 N DISCOVERY PL
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1566
Mailing Address - Country:US
Mailing Address - Phone:509-747-4174
Mailing Address - Fax:
Practice Address - Street 1:2323 N DISCOVERY PL
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1566
Practice Address - Country:US
Practice Address - Phone:509-747-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60949476390200000X, 225700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty