Provider Demographics
NPI:1518352061
Name:FRITCHMAN, SAMARA C (LMHC, CEAP, EAS-C)
Entity Type:Individual
Prefix:MS
First Name:SAMARA
Middle Name:C
Last Name:FRITCHMAN
Suffix:
Gender:F
Credentials:LMHC, CEAP, EAS-C
Other - Prefix:
Other - First Name:SAMARA
Other - Middle Name:KEZELE
Other - Last Name:FRITCHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, CEAP, EAS-C
Mailing Address - Street 1:2536 N NARROWS DR APT 9
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2333
Mailing Address - Country:US
Mailing Address - Phone:253-579-2900
Mailing Address - Fax:
Practice Address - Street 1:4301 S PINE ST STE 501
Practice Address - Street 2:TACOMA MALL OFFICE BUILDING
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7208
Practice Address - Country:US
Practice Address - Phone:253-579-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13522555OtherCAQH