Provider Demographics
NPI:1689027070
Name:SAMANTHA RUNNION, LSCSW, LLC
Entity Type:Organization
Organization Name:SAMANTHA RUNNION, LSCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:VALENE
Authorized Official - Last Name:RUNNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-777-6718
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:BUILDING 1046, SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-777-6718
Mailing Address - Fax:316-462-0629
Practice Address - Street 1:7570 W 21ST ST N.
Practice Address - Street 2:BUILDING 1046, SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-6720
Practice Address - Country:US
Practice Address - Phone:316-777-6718
Practice Address - Fax:316-462-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty