Provider Demographics
NPI:1386507218
Name:SAMANTHA STUBER THERAPEUTICS, PLLC (DBA GLOW COLLECTIVE INTEGRATIVE THERAPY
Entity type:Organization
Organization Name:SAMANTHA STUBER THERAPEUTICS, PLLC (DBA GLOW COLLECTIVE INTEGRATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC, NMIT
Authorized Official - Phone:970-368-3106
Mailing Address - Street 1:PO BOX 5511
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-5511
Mailing Address - Country:US
Mailing Address - Phone:970-368-3106
Mailing Address - Fax:
Practice Address - Street 1:111 E LINCOLN AVE
Practice Address - Street 2:UNIT B
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-368-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-08
Last Update Date:2025-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty