MEDICARE: SAMANTHA HELLER BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144013194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA HELLER BCBA

Provider Business Mailing Address
First Line	:	3012 MERCER DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-4146
Country	:	US
Telephone Number	:	910-445-1672
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3946
Country	:	US
Telephone Number	:	843-666-6746
Fax Number	:

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

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	05/23/2025

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