Provider Demographics
NPI:1831838788
Name:SAMSEL, MARY ELIZABETH ANNE (MA)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELIZABETH ANNE
Last Name:SAMSEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 CLINTON TINNIN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9424
Mailing Address - Country:US
Mailing Address - Phone:601-665-3411
Mailing Address - Fax:
Practice Address - Street 1:5422 CLINTON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3050
Practice Address - Country:US
Practice Address - Phone:601-923-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor