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General NPI Number Information
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NPI Number | 1902619638
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Entity Type | Individual
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Provider Name | SAMANTHA JO EMBRY LPCA
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Gender | Female
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 346 S MAIN ST
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1428
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Country | US
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Telephone | 270-230-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 783 LAWRENCE HAYES RD
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City | CANEYVILLE
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State | KY
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Zip | 42721-9131
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Country | US
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Telephone | 270-230-6166
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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 | 287909
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License Number State | KY
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