MEDICARE: SAMANTHA LYNN SMITH

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1134612161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LYNN SMITH

Provider Business Mailing Address
First Line	:	1800 41ST ST STE 310
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2355
Country	:	US
Telephone Number	:	425-259-3191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 41ST ST STE 310
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2355
Country	:	US
Telephone Number	:	425-259-3191
Fax Number	:

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

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	11/21/2025

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