Provider Demographics
NPI:1457831828
Name:SCHEIDLER, SAM E (MS, QMHP)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:E
Last Name:SCHEIDLER
Suffix:
Gender:M
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:SCHEIDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 SW G ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2544
Mailing Address - Country:US
Mailing Address - Phone:541-476-2373
Mailing Address - Fax:
Practice Address - Street 1:11230 SORRENTO VALLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1300
Practice Address - Country:US
Practice Address - Phone:858-648-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6512101YP2500X
CA16761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional