Provider Demographics
NPI:1417697855
Name:VINCENT, SAMANTHA LYNN (SWLC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917
Mailing Address - Country:US
Mailing Address - Phone:406-885-0961
Mailing Address - Fax:
Practice Address - Street 1:2282 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8499
Practice Address - Country:US
Practice Address - Phone:406-890-2570
Practice Address - Fax:406-203-9949
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MTBBH-SWLC-LIC-38653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical