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General NPI Number Information
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NPI Number | 1942907282
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Entity Type | Individual
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Provider Name | SAMANTHA AYLA KLINKE LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1423 W GARLAND AVE STE B
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City | SPOKANE
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State | WA
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Zip | 99205-2616
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Country | US
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Telephone | 509-557-7209
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 W DALKE AVE
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City | SPOKANE
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State | WA
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Zip | 99205-7315
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Country | US
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Telephone |
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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 | MC61273186
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License Number State | WA
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