Healthcare Provider Details

I. General information

NPI: 1669848339
Provider Name (Legal Business Name): SAMANTHA KOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S WESTERN AVE STE 203
OKLAHOMA CITY OK
73139-1816
US

IV. Provider business mailing address

6801 S WESTERN AVE STE 203
OKLAHOMA CITY OK
73139-1816
US

V. Phone/Fax

Practice location:
  • Phone: 405-245-7059
  • Fax:
Mailing address:
  • Phone: 405-245-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: