Provider Demographics
NPI:1770071045
Name:MCLEAN, SAMANTHA LEAMAN (MFTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEAMAN
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12812 101ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9101
Mailing Address - Country:US
Mailing Address - Phone:253-226-6737
Mailing Address - Fax:
Practice Address - Street 1:1610 56TH CT SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8704
Practice Address - Country:US
Practice Address - Phone:253-226-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60803734101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043407182Medicaid