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General NPI Number Information
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NPI Number | 1861222705
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Entity Type | Individual
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Provider Name | SAMANTHA BROWNELL
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Gender | Female
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 213 N MAIN ST STE 1B
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City | MOSCOW
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State | ID
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Zip | 83843-2700
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Country | US
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Telephone | 208-683-8320
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Fax | 208-969-8380
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Provider Business Mailing Address
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Address Line | 148 S COLE RD
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City | BOISE
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State | ID
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Zip | 83709-0932
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Country | US
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Telephone | 208-683-8320
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Fax | 208-969-8380
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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 | 110512
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License Number State | TX
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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 | 6171142
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License Number State | ID
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