Healthcare Provider Details

I. General information

NPI: 1932014206
Provider Name (Legal Business Name): SAMANTHA MYXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LOGAN AVE
CHEYENNE WY
82001-5138
US

IV. Provider business mailing address

1845 ROSEMARY CT
FORT COLLINS CO
80528-6280
US

V. Phone/Fax

Practice location:
  • Phone: 307-509-0473
  • Fax:
Mailing address:
  • Phone: 970-342-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2604
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: