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General NPI Number Information
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NPI Number | 1134760127
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Entity Type | Individual
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Provider Name | SAMANTHA NUTTALL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/01/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 5310 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74135-5012
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Country | US
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Telephone | 918-641-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 E 137TH ST
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City | GLENPOOL
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State | OK
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Zip | 74033-3258
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Country | US
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Telephone | 918-240-8728
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8405
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License Number State | OK
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