Samantha Kountz-Edwards

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY28660 Issued in CA

Practice address

1588 Hallbrook Dr
San Jose, CA 95118-1611

Phone

(408) 209-0896

NPI assigned

Jan 10, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Samantha Kountz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1104362433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1588 HALLBROOK DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951181611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1588 HALLBROOK DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951181611",
            "telephone_number": "408-209-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUNTZ-EDWARDS",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY28660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "KOUNTZ",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Psychologist in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.