Provider Demographics
NPI:1154461192
Name:PANKEY, SAMANTHA RENEE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:RENEE
Last Name:PANKEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NEW STINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-3696
Mailing Address - Country:US
Mailing Address - Phone:661-322-4000
Mailing Address - Fax:661-873-9314
Practice Address - Street 1:1601 NEW STINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-3696
Practice Address - Country:US
Practice Address - Phone:661-322-4000
Practice Address - Fax:661-873-9314
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist