Provider Demographics
NPI:1700364288
Name:MARSTON, SAMANTHA (T-LMLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MARSTON
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18063 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7681
Mailing Address - Country:US
Mailing Address - Phone:417-388-3266
Mailing Address - Fax:
Practice Address - Street 1:2619 W 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4300
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist