Provider Demographics
NPI:1841748522
Name:SAMPSON, TRENT HAROY
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:HAROY
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TRENT
Other - Middle Name:HAROY
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASSOCIATES
Mailing Address - Street 1:116 CIARA LN
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1454
Mailing Address - Country:US
Mailing Address - Phone:318-957-1190
Mailing Address - Fax:
Practice Address - Street 1:116 CIARA LN
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1454
Practice Address - Country:US
Practice Address - Phone:318-957-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health