Individual
SAMANTHA GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1654 BRYAN RD, O FALLON, MO 63368-4897
(636) 344-0433
Mailing address
312 ROSE BRANCHLET CT, WENTZVILLE, MO 63385-6008
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2023041161
MO
Other
Enumeration date
06/14/2024
Last updated
06/14/2024
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