Healthcare Provider Details

I. General information

NPI: 1659234961
Provider Name (Legal Business Name): SAMANTHA NICOLE BENZING PCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 LORI LN
BOZEMAN MT
59718-2211
US

IV. Provider business mailing address

3039 LORI LN
BOZEMAN MT
59718-2211
US

V. Phone/Fax

Practice location:
  • Phone: 208-577-8430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBBH-PCLC-LIC-84158
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: