Samantha Buckley
Individual provider Active NPI Mental Health Counselor · Columbia, MS
NPI 1316616832 · NPPES record last updated Sep 8, 2021
Key facts
- NPI
- 1316616832
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 4812 (MS)
- Practice address
- 217 Dewey St
Columbia, MS 39429-2751 - Phone
- (601) 736-6799
- Fax
- (601) 736-4809
- NPI assigned
- Sep 8, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4812 | MS | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Region 12 Commission on Mental Health & Retardation Pine Belt Men | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4812 | MS | Yes |
Addresses
Primary practice location
217 Dewey St
Columbia, MS 39429-2751
Mailing address
PO Box 18679
Hattiesburg, MS 39404-8679
Phone (601) 705-1901
Other providers in Columbia, MS
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- Alicia Brister
- Cody O'Neal Broom
- Kristyn McDaniel Bumpers
- Zane Bumpers
- Regena Burton
- C,S&C Transportation LLC
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All providers in Columbia, MS · Mental Health Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.