Healthcare Provider Details

I. General information

NPI: 1124423041
Provider Name (Legal Business Name): SAMANTHA BURNS ARTHERHOLT, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 STEWART ST STE 724
SEATTLE WA
98101-1227
US

IV. Provider business mailing address

PO BOX 27136
SEATTLE WA
98165-1536
US

V. Phone/Fax

Practice location:
  • Phone: 414-533-5825
  • Fax:
Mailing address:
  • Phone: 414-533-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberPY00003648
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SAMANTHA BURNS ARTHERHOLT
Title or Position: MEMBER/OWNER
Credential: PHD
Phone: 206-412-0142