Provider Demographics
NPI:1679751085
Name:SAMMONS, JOSEPH S (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:SAMMONS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:J.
Other - Middle Name:S
Other - Last Name:SAMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:162 WELLS DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1520
Mailing Address - Country:US
Mailing Address - Phone:606-886-8568
Mailing Address - Fax:
Practice Address - Street 1:162 WELLS DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1520
Practice Address - Country:US
Practice Address - Phone:606-886-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0153101Y00000X
KY0792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor