Provider Demographics
NPI:1992217251
Name:GOLDEN, SAMANTHA L (LMFT, CMHC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LMFT, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5814 S 900 E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1644
Mailing Address - Country:US
Mailing Address - Phone:385-800-3272
Mailing Address - Fax:
Practice Address - Street 1:5814 S 900 E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1644
Practice Address - Country:US
Practice Address - Phone:385-800-3272
Practice Address - Fax:385-800-3260
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11862129-6004101YM0800X
OHE.2001656101YP2500X
KY268693101YP2500X
OHM.1700051106H00000X
OHF.2000150106H00000X
UT11862129-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0252626Medicaid
UT1992217251Medicaid