Provider Demographics
NPI:1326591785
Name:PAXSON, SAMANTHA (LCPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PAXSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:519 MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-3037
Mailing Address - Country:US
Mailing Address - Phone:406-945-3995
Mailing Address - Fax:
Practice Address - Street 1:519 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3037
Practice Address - Country:US
Practice Address - Phone:406-945-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17903101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health