Provider Demographics
NPI:1417697855
Name:VINCENT, SAMANTHA LYNN (SWLC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 9TH ST W
Mailing Address - Street 2:TRL 12
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-4416
Mailing Address - Country:US
Mailing Address - Phone:406-885-0961
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2731
Practice Address - Country:US
Practice Address - Phone:406-745-3681
Practice Address - Fax:406-756-3686
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health