Provider Demographics
NPI:1417438946
Name:BYRNE, SAMANTHA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELAINE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:607 KITLOU CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9170
Mailing Address - Country:US
Mailing Address - Phone:734-645-0301
Mailing Address - Fax:
Practice Address - Street 1:607 KITLOU CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9170
Practice Address - Country:US
Practice Address - Phone:734-645-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1801334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional