Provider Demographics
NPI:1588272488
Name:VAUGHT, SAMANTHA ROSE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ROSE
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ROSE
Other - Last Name:CATANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW U/S
Mailing Address - Street 1:1380 CREEKSIDE DR APT 801
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1930
Mailing Address - Country:US
Mailing Address - Phone:405-535-7908
Mailing Address - Fax:
Practice Address - Street 1:4436 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2212
Practice Address - Country:US
Practice Address - Phone:405-535-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK8872104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator