Individual provider Active NPI

Samantha K Mangum

  • Mental Health Counselor
  • Boulder, CO
National Provider Identifier
1942593694
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
1333 Iris Ave
Boulder, CO 80304-2226
Phone
(303) 444-9126
NPI assigned
May 26, 2011
Last updated
May 26, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

1333 Iris Ave
Boulder, CO 80304-2226

Mailing address

1460 S Ash St
Denver, CO 80222-3628
Phone (210) 875-7533

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250325004138 CO Practitioner - Mental Health Counselor 8820511355 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

975 N St
Boulder, CO 80304
Phone (303) 443-8500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Campesina Family Health Services CurrentSince Feb 20, 2025 Accepting new patients
Clinica Campesina Family Health Services Current Accepting new patients
Clinica Campesina Family Health Services CurrentSince Feb 20, 2025 Accepting new patients

Locations

1000 Alpine Ave
Boulder, CO 80304
Phone (303) 332-1250

1333 Iris Ave
Boulder, CO 80304
Phone (303) 413-6212

3180 Airport Rd
Boulder, CO 80301
Phone (303) 378-6668

975 North St
Boulder, CO 80304
Phone (303) 440-7941

1455 Dixon Ave
Lafayette, CO 80026
Phone (720) 406-3604

1455 Dixon Ave
Ste 300
Lafayette, CO 80026
Phone (303) 604-4244

1735 S Public Rd
Lafayette, CO 80026
Phone 30366530361061

1735 S Public Rd
Ste 203
Lafayette, CO 80026

515 Coffman St
Longmont, CO 80501
Phone (303) 409-0135

834 S Sherman St
Longmont, CO 80501
Phone (303) 247-8700

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

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": "1306368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306368000000",
    "number": "1942593694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 S ASH ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802223628",
            "telephone_number": "210-875-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-444-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUM",
        "first_name": "SAMANTHA",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.