Provider Demographics
NPI:1386533875
Name:PROULX, SAMANTHA REILLY (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:REILLY
Last Name:PROULX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 JD FARM RD
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385-5244
Mailing Address - Country:US
Mailing Address - Phone:423-519-1699
Mailing Address - Fax:
Practice Address - Street 1:930 ADELL REE PARK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2543
Practice Address - Country:US
Practice Address - Phone:865-769-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15424104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker