MEDICARE: SAMANTHA SUSAN SPENCER MA, LPC

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	101YM0800X	Mental Health Counselor	0019407	CO
2	101YP2500X	Professional Counselor	LPC.0019407	CO

General Provider Information

NPI Number	:	1093280232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SUSAN SPENCER MA, LPC

Provider Business Mailing Address
First Line	:	77 3RD ST STE 400
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8179
Country	:	US
Telephone Number	:	719-259-4951
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 3RD ST STE 400
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-8179
Country	:	US
Telephone Number	:	719-259-4951
Fax Number	:

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

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	02/20/2024

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