Provider Demographics
NPI:1619377595
Name:SAMPSON FAMILY THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:SAMPSON FAMILY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:319-290-1659
Mailing Address - Street 1:309 COURT AVE
Mailing Address - Street 2:SUITE 241
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2245
Mailing Address - Country:US
Mailing Address - Phone:515-875-4816
Mailing Address - Fax:515-875-4817
Practice Address - Street 1:309 COURT AVE
Practice Address - Street 2:SUITE 241
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2245
Practice Address - Country:US
Practice Address - Phone:515-875-4816
Practice Address - Fax:515-875-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty