Provider Demographics
NPI:1831844000
Name:VAN HORN, SAMANTHA JEAN (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEAN
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 M ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0755
Mailing Address - Country:US
Mailing Address - Phone:209-522-9568
Mailing Address - Fax:209-522-8621
Practice Address - Street 1:1101 M ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0755
Practice Address - Country:US
Practice Address - Phone:209-522-9568
Practice Address - Fax:209-522-8621
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist