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General NPI Number Information
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NPI Number | 1992291702
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Entity Type | Individual
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Provider Name | SAMANTHA TRIMBLE
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Gender | Female
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 7375 WOODWARD AVE STE 2800
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City | DETROIT
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State | MI
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Zip | 48202-3157
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Country | US
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Telephone | 313-251-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N PACIFIC COAST HWY STE 1400
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5602
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401001455
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License Number State | MI
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