MEDICARE: SAMANTHA UPSHAW MAXEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1320	KY
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	104439	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083997886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA UPSHAW MAXEY

Provider Business Mailing Address
First Line	:	332 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-200-4961
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-200-4961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	03/17/2018

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