Provider Demographics
NPI:1164651253
Name:PANOS, SAMM HARPER
Entity Type:Individual
Prefix:MISS
First Name:SAMM
Middle Name:HARPER
Last Name:PANOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2502
Mailing Address - Country:US
Mailing Address - Phone:602-839-3956
Mailing Address - Fax:602-839-0589
Practice Address - Street 1:4550 E BELL RD STE 147
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9381
Practice Address - Country:US
Practice Address - Phone:602-633-6200
Practice Address - Fax:602-633-6227
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health