Provider Demographics
NPI:1083961858
Name:HOUSE, SAMPSON
Entity Type:Individual
Prefix:
First Name:SAMPSON
Middle Name:
Last Name:HOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 W 33RD ST
Mailing Address - Street 2:SUITE NUMBER B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3835
Mailing Address - Country:US
Mailing Address - Phone:405-216-5608
Mailing Address - Fax:
Practice Address - Street 1:1729 W 33RD ST
Practice Address - Street 2:SUITE NUMBER B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3835
Practice Address - Country:US
Practice Address - Phone:405-216-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health