Healthcare Provider Details

I. General information

NPI: 1174395735
Provider Name (Legal Business Name): SAMANTHA RAE GORHAM LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 PACIFIC AVE STE C3
TACOMA WA
98408-7423
US

IV. Provider business mailing address

710 N 104TH ST
SEATTLE WA
98133-9212
US

V. Phone/Fax

Practice location:
  • Phone: 253-363-8853
  • Fax:
Mailing address:
  • Phone: 206-383-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61505856
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: