MEDICARE: SAMANTHA SMITH

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
1	101Y00000X	Counselor	007130449	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578920476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SMITH

Provider Business Mailing Address
First Line	:	3772 YOUREE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3772 YOUREE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2132
Country	:	US
Telephone Number	:	318-670-3159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	01/22/2016

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Directions to “ SAMANTHA SMITH ” Practice Location

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