Provider Demographics
NPI:1629740741
Name:SAMP, ROBERT JAMES III (LPC, CMPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:SAMP
Suffix:III
Gender:M
Credentials:LPC, CMPC, CADC
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:
Other - Last Name:SAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 E 9TH ST APT 609
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2142
Mailing Address - Country:US
Mailing Address - Phone:630-336-5117
Mailing Address - Fax:
Practice Address - Street 1:1770 PARK ST STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1244
Practice Address - Country:US
Practice Address - Phone:630-305-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health