Provider Demographics
NPI:1073893871
Name:SAMMONS, JANICE RELPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:RELPH
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2326
Mailing Address - Country:US
Mailing Address - Phone:520-296-4280
Mailing Address - Fax:520-296-3835
Practice Address - Street 1:1980 E FORT LOWELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2326
Practice Address - Country:US
Practice Address - Phone:520-296-4280
Practice Address - Fax:520-296-3835
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4202103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148052Medicare PIN