Healthcare Provider Details

I. General information

NPI: 1326591785
Provider Name (Legal Business Name): SAMANTHA PAXSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA PIERSON LCPC

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MAIN ST STE 103
MILES CITY MT
59301-3037
US

IV. Provider business mailing address

519 MAIN ST STE 103
MILES CITY MT
59301-3037
US

V. Phone/Fax

Practice location:
  • Phone: 406-945-3995
  • Fax:
Mailing address:
  • Phone: 406-945-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number17903
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17903
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: