Healthcare Provider Details

I. General information

NPI: 1831594316
Provider Name (Legal Business Name): SAMANTHA SIEGEL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 LOWELL BLVD.
DENVER CO
80211
US

IV. Provider business mailing address

4159 LOWELL BLVD.
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-7220
  • Fax:
Mailing address:
  • Phone: 303-458-7220
  • 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:
Title or Position:
Credential:
Phone: