Healthcare Provider Details

I. General information

NPI: 1841764727
Provider Name (Legal Business Name): SAMANTHA ARNOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ROWE LCSW

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S RAILROAD AVE
SUGAR CITY ID
83448-5072
US

IV. Provider business mailing address

PO BOX 4789
POCATELLO ID
83205-4789
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-0519
  • Fax: 208-359-2493
Mailing address:
  • Phone: 208-359-0519
  • Fax: 208-359-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-38266
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: