Provider Demographics
NPI:1497970958
Name:SAMPSELL, LISA KIM (LCSW LISAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KIM
Last Name:SAMPSELL
Suffix:
Gender:F
Credentials:LCSW LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E MITCHELL DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2330
Mailing Address - Country:US
Mailing Address - Phone:602-995-7474
Mailing Address - Fax:602-254-5666
Practice Address - Street 1:40 E MITCHELL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2330
Practice Address - Country:US
Practice Address - Phone:602-995-7474
Practice Address - Fax:602-254-5666
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 103651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical