| Doctor Name: | SAMANTHA COUP |
| NPI Number: | 1558771824 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 304 N Jefferson Ave Iola, KS - 667492327 |
| Business Phone Number: | 6203655717 |
| Business Fax Number: | |
| Mailing Address: | 1501 George Williams Way Apt E12, LAWRENCE |
| State: | KS |
| Postal Code: | 660479337 |
| Phone Number: | 7853660313 |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2014 |
| NPI Last Update Date: | 05/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |