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General NPI Number Information
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NPI Number | 1386507218
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Entity Type | Organization
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Legal Business Name | SAMANTHA STUBER THERAPEUTICS, PLLC (DBA GLOW COLLECTIVE INTEGRATIVE THERAPY
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 111 E LINCOLN AVE UNIT B
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City | BRECKENRIDGE
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State | CO
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Zip | 80424
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Country | US
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Telephone | 970-368-3106
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5511
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City | FRISCO
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State | CO
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Zip | 80443-5511
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Country | US
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Telephone | 970-368-3106
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | SAMANTHA JOHNSON
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Credential | MA, LPC, LAC, NMIT
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Telephone | 970-368-3106
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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 |
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License Number State |
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