Healthcare Provider Details

I. General information

NPI: 1144428905
Provider Name (Legal Business Name): SAMANTHA FELTS PAULEY LPC, LMFT, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA JEAN FELTS

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 SW 105TH AVE STE 115
BEAVERTON OR
97008-8833
US

IV. Provider business mailing address

8625 SW LIZZIE CT
TIGARD OR
97223-7097
US

V. Phone/Fax

Practice location:
  • Phone: 503-644-7300
  • Fax:
Mailing address:
  • Phone: 503-505-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: