Provider Demographics
NPI:1932402732
Name:LAURIE, SAMANTHA WEBER
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:WEBER
Last Name:LAURIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 INDEPENDENCE CIR STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4909
Mailing Address - Country:US
Mailing Address - Phone:530-521-5818
Mailing Address - Fax:530-521-5818
Practice Address - Street 1:55 INDEPENDENCE CIR STE 106
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4909
Practice Address - Country:US
Practice Address - Phone:530-521-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117785106H00000X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932402732OtherUNK
CA1932402737OtherNPI