Provider Demographics
NPI:1205697208
Name:GOUDY, SAMANTHA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:GOUDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 KRISRON RD UNIT C-205
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6765
Mailing Address - Country:US
Mailing Address - Phone:970-590-9080
Mailing Address - Fax:
Practice Address - Street 1:2133 KRISRON RD UNIT C-205
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6765
Practice Address - Country:US
Practice Address - Phone:970-590-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26916-C1041C0700X
COCSW.099273641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical