Basic Information
| Provider Information | |||||||||
| NPI: | 1750854808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREASE | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | MA, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1925 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448704737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195575177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 335 BUCKEYE BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT CLINTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434521423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197342942 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E.2203118 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.