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General NPI Number Information
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NPI Number | 1700672326
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Entity Type | Individual
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Provider Name | SAMANTHA DETAR LMHCA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 801 SHELBY ST STE 212
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-1163
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Country | US
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Telephone | 888-721-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SHELBY ST STE 212
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City | INDIANAPOLIS
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State | IN
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Zip | 46203-1163
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Country | US
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Telephone | 888-721-3003
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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 | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88002768A
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License Number State | IN
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