MEDICARE: SAMANTHA JOYCLE PORTH

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		OR

General Provider Information

NPI Number	:	1366306052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JOYCLE PORTH

Provider Business Mailing Address
First Line	:	289 SW 6TH PL
Second Line	:
City	:	CANBY
State	:	OR
Zip	:	97013-4111
Country	:	US
Telephone Number	:	971-901-2731
Fax Number	:	971-901-3065

Provider Business Practice Location Address
First Line	:	6444 FAIRWAY AVE SE STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-3073
Country	:	US
Telephone Number	:	971-901-2731
Fax Number	:	971-901-3065

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “ SAMANTHA JOYCLE PORTH ” Practice Location

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