Individual
SAMANTHA K TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I/QMHA
Contact information
Practice address
620 NE 2ND ST, GRESHAM, OR 97030
(971) 274-3757
(503) 912-5740
Mailing address
13030 SE RUSK RD APT 12, MILWAUKIE, OR 97222-2184
(971) 295-7751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-04-27
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-18-122
OR
101YM0800X
Mental Health Counselor
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500744091
—
OR
05
—
500746027
—
OR
Enumeration date
05/30/2018
Last updated
03/28/2019
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