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General NPI Number Information
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NPI Number | 1518842285
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Entity Type | Organization
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Legal Business Name | SAMANTHA GOUDY LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2133 KRISRON RD UNIT C-205
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City | FORT COLLINS
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State | CO
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Zip | 80525-6765
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Country | US
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Telephone | 970-590-9080
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Fax |
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Provider Business Mailing Address
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Address Line | 2133 KRISRON RD UNIT C-205
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City | FORT COLLINS
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State | CO
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Zip | 80525-6765
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Country | US
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Telephone | 970-590-9080
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Fax |
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Authorized Official
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Title or Position | LCSW THERAPIST
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Name | MRS. SAMANTHA ANN GOUDY
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Credential | LCSW
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Telephone | 970-590-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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