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General NPI Number Information
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NPI Number | 1356104939
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Entity Type | Individual
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Provider Name | SAMANTHA CARAN MS, LAC
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Gender | Female
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE STE 314
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City | GLENDALE
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State | AZ
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Zip | 85308-8730
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Country | US
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Telephone | 623-866-3375
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Fax |
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Provider Business Mailing Address
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Address Line | 16482 N 67TH LN
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City | PEORIA
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State | AZ
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Zip | 85382-3979
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-20738
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License Number State | AZ
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