Provider Demographics
NPI:1699008003
Name:TAYLOR, SAMANTHA B (M ED, LPCC-S)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:M ED, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 VINTAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-2901
Mailing Address - Country:US
Mailing Address - Phone:907-463-0100
Mailing Address - Fax:
Practice Address - Street 1:3051 VINTAGE BLVD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-2901
Practice Address - Country:US
Practice Address - Phone:907-463-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1133101YP2500X
101YP2500X
KY201116931101YS0200X
OHE.0006878-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool