Provider Demographics
NPI:1508497827
Name:FAULKNER, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N 27TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-5122
Mailing Address - Country:US
Mailing Address - Phone:918-944-3790
Mailing Address - Fax:
Practice Address - Street 1:1608 S ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4208
Practice Address - Country:US
Practice Address - Phone:918-587-3888
Practice Address - Fax:918-587-3891
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool