Provider Demographics
NPI:1700166485
Name:HALL, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KIRKENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20275 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3962
Mailing Address - Country:US
Mailing Address - Phone:402-933-5700
Mailing Address - Fax:402-933-9998
Practice Address - Street 1:20275 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3962
Practice Address - Country:US
Practice Address - Phone:402-933-5700
Practice Address - Fax:402-933-9998
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health