NPIMap

Individual provider Active NPI

Samantha Stumbo, LMFT, TCADC

  • Marriage & Family Therapist
  • McDowell, KY
National Provider Identifier
1609287226
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
276031 Issued in KY
Practice address
9575 Ky Hwy 122
Suite 6
McDowell, KY 41647-1614
Phone
(606) 949-1623
NPI assigned
May 16, 2014
Last updated
Mar 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 283137 KY
Marriage & Family Therapist 106H00000X 276031 KY Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

9575 Ky Hwy 122
Suite 6
McDowell, KY 41647-1614

Mailing address

PO Box 41
MC Dowell, KY 41647-0041
Phone (606) 359-0700

Other identifiers 2

IdentifierTypeStateIssuer
7100674370MedicaidKY
7100802100MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address samantha@purposedrivensupports.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
283137KYMDAddiction (Substance Use Disorder) Counselor
276031KYMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Purpose Driven Support Services CurrentSince Jun 21, 2022 Accepting new patients
Sisters Purpose Behavioral Health Clinic Current Accepting new patients
Purpose Driven Intervention Services Addiction (Substance Use Disorder) Current Accepting new patients
Purpose Driven Support Services Addiction (Substance Use Disorder) CurrentSince Mar 20, 2022 Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1609287226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41",
            "city": "MC DOWELL",
            "state": "KY",
            "postal_code": "416470041",
            "telephone_number": "606-359-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9575 KY HWY 122",
            "address_2": "SUITE 6",
            "city": "MCDOWELL",
            "state": "KY",
            "postal_code": "416471614",
            "telephone_number": "606-949-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUMBO",
        "first_name": "SAMANTHA",
        "credential": "LMFT, TCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-16",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "283137",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "KY",
            "license": "276031",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100674370",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100802100",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "samantha@purposedrivensupports.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9575 KY HWY 122",
            "address_2": "Suite 6",
            "city": "McDowell",
            "state": "KY",
            "country_code": "US",
            "postal_code": "416471614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in McDowell, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.