=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124423041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMANTHA BURNS ARTHERHOLT, PHD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2014
-----------------------------------------------------
Last Update Date | 12/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 STEWART ST STE 724
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98101-1227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-533-5825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27136
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98165-1536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-533-5825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | DR. SAMANTHA BURNS ARTHERHOLT
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 206-412-0142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | PY00003648
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------