Healthcare Provider Details

I. General information

NPI: 1386507218
Provider Name (Legal Business Name): SAMANTHA STUBER THERAPEUTICS, PLLC (DBA GLOW COLLECTIVE INTEGRATIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E LINCOLN AVE UNIT B
BRECKENRIDGE CO
80424
US

IV. Provider business mailing address

PO BOX 5511
FRISCO CO
80443-5511
US

V. Phone/Fax

Practice location:
  • Phone: 970-368-3106
  • Fax:
Mailing address:
  • Phone: 970-368-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA JOHNSON
Title or Position: OWNER, THERAPIST
Credential: MA, LPC, LAC, NMIT
Phone: 970-368-3106