Provider Demographics
NPI:1205843679
Name:SAMSELL, SHARON DORA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DORA
Last Name:SAMSELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DORA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:7062 N COUNTY ROAD 725 E
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:IN
Mailing Address - Zip Code:46105-9423
Mailing Address - Country:US
Mailing Address - Phone:765-522-1526
Mailing Address - Fax:
Practice Address - Street 1:7062 N COUNTY ROAD 725 E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-9423
Practice Address - Country:US
Practice Address - Phone:765-522-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001052A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health