Provider Demographics
NPI:1164164943
Name:ROTT, SAMANTHA (MA, MFTA, PCA, LMHCA)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:ROTT
Suffix:
Gender:F
Credentials:MA, MFTA, PCA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 SW HUNZIKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2303
Mailing Address - Country:US
Mailing Address - Phone:971-300-4959
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-2303
Practice Address - Country:US
Practice Address - Phone:971-300-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC10972101YM0800X
WAMC61470069101YM0800X
ORR8410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist