Provider Demographics
NPI:1891220943
Name:VANDEPUTTE, SAMANTHA NORRIS (LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NORRIS
Last Name:VANDEPUTTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-9556
Mailing Address - Country:US
Mailing Address - Phone:559-277-9089
Mailing Address - Fax:
Practice Address - Street 1:6224 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93723-9556
Practice Address - Country:US
Practice Address - Phone:559-277-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA99129106H00000X
CA135745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health