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General NPI Number Information
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NPI Number | 1922836394
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Entity Type | Individual
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Provider Name | SAMANTHA BREYFOGLE LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 3425 N FUTRALL DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4811
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Country | US
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Telephone | 479-713-8000
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Fax | 479-713-8375
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Provider Business Mailing Address
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Address Line | 1900 KIMBROUGH ST APT A
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City | SPRINGDALE
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State | AR
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Zip | 72762-1523
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Country | US
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Telephone | 479-800-1555
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M2406004
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License Number State | AR
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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 | P2405006
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License Number State | AR
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