Provider Demographics
NPI:1306401989
Name:CURTIS, SAMANTHA L (ACMHC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:CURTIS
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1911
Mailing Address - Country:US
Mailing Address - Phone:385-528-2950
Mailing Address - Fax:
Practice Address - Street 1:1719 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1911
Practice Address - Country:US
Practice Address - Phone:385-528-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13071869-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT13071869-6009OtherDOPL UTAH CHAPTER