Healthcare Provider Details

I. General information

NPI: 1548833437
Provider Name (Legal Business Name): SAMANTHA MICHELLE PURCELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA ESTES

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S HIGH ST STE 220
COLUMBUS OH
43215-5644
US

IV. Provider business mailing address

354 FRANKFORT SQ
COLUMBUS OH
43206-1061
US

V. Phone/Fax

Practice location:
  • Phone: 614-625-7183
  • Fax:
Mailing address:
  • Phone: 606-560-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-175947
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2305687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: