Provider Demographics
NPI:1518842285
Name:SAMANTHA GOUDY LLC
Entity type:Organization
Organization Name:SAMANTHA GOUDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOUDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-590-9080
Mailing Address - Street 1:2133 KRISRON RD UNIT C-205
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6765
Mailing Address - Country:US
Mailing Address - Phone:970-590-9080
Mailing Address - Fax:
Practice Address - Street 1:2133 KRISRON RD UNIT C-205
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6765
Practice Address - Country:US
Practice Address - Phone:970-590-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty