Provider Demographics
NPI:1053088054
Name:KITCHEN, SAMANTHA (MFT-T)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:MFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 E WASHINGTON ST STE 150
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3339
Mailing Address - Country:US
Mailing Address - Phone:330-241-4444
Mailing Address - Fax:
Practice Address - Street 1:807 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3339
Practice Address - Country:US
Practice Address - Phone:330-241-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2100229-TRNE106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist