Provider Demographics
NPI:1154556165
Name:SAMSEL, NANCY (MFT #52231)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:SAMSEL
Suffix:
Gender:F
Credentials:MFT #52231
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313A CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4387
Mailing Address - Country:US
Mailing Address - Phone:831-252-4195
Mailing Address - Fax:
Practice Address - Street 1:313A CEDAR ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4387
Practice Address - Country:US
Practice Address - Phone:831-252-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 43307OtherITERN