Provider Demographics
NPI:1659146660
Name:RICH, SAMANTHA ANN (MED, LMHCA, NCC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ANN
Last Name:RICH
Suffix:
Gender:F
Credentials:MED, LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 CLIFFORD WAY
Mailing Address - Street 2:
Mailing Address - City:BURNS HARBOR
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9690
Mailing Address - Country:US
Mailing Address - Phone:219-929-6071
Mailing Address - Fax:
Practice Address - Street 1:9250 COLUMBIA AVE STE 2A
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3530
Practice Address - Country:US
Practice Address - Phone:219-595-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019448101YM0800X
IN88001442A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health