Provider Demographics
NPI:1881337624
Name:ZOLLER, SAMANTHA MARILYN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARILYN
Last Name:ZOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SUMMIT RIDGE DR APT 8621
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9079
Mailing Address - Country:US
Mailing Address - Phone:916-221-8758
Mailing Address - Fax:
Practice Address - Street 1:850 MILL ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1463
Practice Address - Country:US
Practice Address - Phone:775-538-6700
Practice Address - Fax:775-688-5878
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health