Healthcare Provider Details

I. General information

NPI: 1881414092
Provider Name (Legal Business Name): SAMANTHA ELIZABETH MCNEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 E PARK BLVD
BOISE ID
83712-7722
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-5970
  • Fax: 208-381-5971
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1271980
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: