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NPI Code Detail

MEDICARE: SAMANTHA ANN AVIS M.ED., LPCC

MEDICARE: SAMANTHA ANN AVIS M.ED., LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor172816KY
2101YM0800XMental Health Counselor172816KY

General Provider Information

NPI Number : 1376943951
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANN AVIS M.ED., LPCC
Provider Business Mailing Address
First Line : 1198 CROSSPOINTE DR
Second Line :
City : HEBRON
State : KY
Zip : 41048-7330
Country : US
Telephone Number : 513-277-1013
Fax Number :
Provider Business Practice Location Address
First Line : 7000 HOUSTON RD STE 2
Second Line :
City : FLORENCE
State : KY
Zip : 41042-4874
Country : US
Telephone Number : 513-277-1013
Fax Number : 859-993-6958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2014
Last Update Date : 03/28/2024

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