Provider Demographics
NPI:1548565955
Name:CARLTON, SAMANTHA DANIELLE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANIELLE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DANIELLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 NW 63RD ST
Mailing Address - Street 2:STE.100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1549
Mailing Address - Country:US
Mailing Address - Phone:405-242-2969
Mailing Address - Fax:405-421-0818
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:STE.100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1549
Practice Address - Country:US
Practice Address - Phone:405-242-2969
Practice Address - Fax:405-421-0818
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist