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General NPI Number Information
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NPI Number | 1083418768
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Entity Type | Individual
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Provider Name | SAMANTHA KYLE FLORES ATIENZA CBT
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 110 2ND ST SW STE 140
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City | AUBURN
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State | WA
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Zip | 98001-5203
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Country | US
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Telephone | 206-480-6344
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 S 360TH ST UNIT C
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB61660199
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License Number State | WA
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