Provider Demographics
NPI:1811415656
Name:GARNER, SAMANTHA RAE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-4204
Mailing Address - Country:US
Mailing Address - Phone:918-604-6054
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:124 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-4204
Practice Address - Country:US
Practice Address - Phone:918-604-6054
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK7131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor