Provider Demographics
NPI:1649370495
Name:SENTELL, SAMUEL WEBB (PHD MP)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WEBB
Last Name:SENTELL
Suffix:
Gender:M
Credentials:PHD MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6146
Mailing Address - Country:US
Mailing Address - Phone:318-868-2001
Mailing Address - Fax:318-675-1517
Practice Address - Street 1:8504 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6146
Practice Address - Country:US
Practice Address - Phone:318-868-2001
Practice Address - Fax:318-675-1517
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA722 MP103G00000X, 103TC0700X, 103TC2200X, 106H00000X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist