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General NPI Number Information
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NPI Number | 1972270072
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Entity Type | Individual
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Provider Name | SAMANTHA LARSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 09/12/2021
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Provider Practice Location Address
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Address Line | 1216 16TH ST W STE 31
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City | BILLINGS
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State | MT
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Zip | 59102-4100
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Country | US
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Telephone | 406-274-7623
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 CALENDULA CIR
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City | BILLINGS
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State | MT
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Zip | 59105-2370
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Country | US
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Telephone | 406-208-6484
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-50241
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License Number State | MT
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