Provider Demographics
NPI:1730749417
Name:STITES, SAMANTHA (LMSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:STITES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MISSION RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1319
Mailing Address - Country:US
Mailing Address - Phone:231-944-2529
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD STE 230
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1319
Practice Address - Country:US
Practice Address - Phone:913-735-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker