Basic Information
| Provider Information | |||||||||
| NPI: | 1750029344 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMANTHA GOODWIN LMSW LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 854 | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488050854 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 441 SWARTZ CT | ||||||||
| Address2: | |||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488462157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165236537 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2022 | ||||||||
| LastUpdateDate: | 05/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | GOODWIN | ||||||||
| AuthorizedOfficialFirstName: | SAMANTHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6165236537 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.