MEDICARE: SAMANTHA ALEXIS STETHEM

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1952250474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ALEXIS STETHEM

Provider Business Mailing Address
First Line	:	7500 SAN FELIPE ST STE 990
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1708
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	866-611-1558

Provider Business Practice Location Address
First Line	:	4196 DOUGLAS BLVD STE 100
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-5904
Country	:	US
Telephone Number	:	916-489-1376
Fax Number	:

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ SAMANTHA ALEXIS STETHEM ” Practice Location

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