MEDICARE: MARLA SAMUEL DBA DRAGONFLY TRANSFORMATIONAL ARTS LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861032492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLA SAMUEL DBA DRAGONFLY TRANSFORMATIONAL ARTS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1787
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-0261
Country	:	US
Telephone Number	:	541-500-8655
Fax Number	:	800-433-1396

Provider Business Practice Location Address
First Line	:	575 FAITH AVE
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-2508
Country	:	US
Telephone Number	:	541-500-8655
Fax Number	:	800-433-1396

Authorized Official
Title or Position	:	OWNER
Name	:	MARLA SAMUEL
Credential	:	LCSW
Telephone Number	:	541-500-8655

Provider Enumeration Date	:	01/11/2020
Last Update Date	:	04/05/2024

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