Provider Demographics
NPI:1760963706
Name:SAMPSON, TRACEY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-3109
Mailing Address - Country:US
Mailing Address - Phone:814-450-6325
Mailing Address - Fax:
Practice Address - Street 1:2931 HARVARD RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1220
Practice Address - Country:US
Practice Address - Phone:814-453-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional