Healthcare Provider Details

I. General information

NPI: 1891628244
Provider Name (Legal Business Name): SAMANTHA DAYLE THOMLINSON PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA SOUTHWORTH

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W 10TH ST STE 300
ROLLA MO
65401-2905
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax: 660-885-3690
Mailing address:
  • Phone: 844-853-8937
  • Fax: 660-885-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026023958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: