Provider Demographics
NPI:1750796199
Name:HORSTMAN, SAMANTHA JEAN (LMFT LADC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:HORSTMAN
Suffix:
Gender:F
Credentials:LMFT LADC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JEAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:YOUR PATH
Mailing Address - Street 2:700 RAYMOND AVE SUITE 130
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:952-496-8172
Mailing Address - Fax:952-496-8355
Practice Address - Street 1:YOUR PATH 700 RAYMOND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:952-496-8172
Practice Address - Fax:952-496-8355
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303761101YA0400X
MNLMFT 2951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)