Healthcare Provider Details

I. General information

NPI: 1255722328
Provider Name (Legal Business Name): SAMANTHA COLAI LMFT, RPT, SEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 15TH ST NW
NEW BRIGHTON MN
55112-5605
US

IV. Provider business mailing address

2475 15TH ST NW STE D
NEW BRIGHTON MN
55112-5606
US

V. Phone/Fax

Practice location:
  • Phone: 612-406-4083
  • Fax: 612-439-8907
Mailing address:
  • Phone: 651-328-3423
  • Fax: 612-439-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3107
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: