Provider Demographics
NPI:1457760985
Name:WILLEY, SAMANTHA R (MS, LMHP, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:R
Last Name:WILLEY
Suffix:
Gender:F
Credentials:MS, LMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 S 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2709
Mailing Address - Country:US
Mailing Address - Phone:402-578-8089
Mailing Address - Fax:
Practice Address - Street 1:820 S 75TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4623
Practice Address - Country:US
Practice Address - Phone:402-391-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4442101YM0800X
NE2161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health