Basic Information
| Provider Information | |||||||||
| NPI: | 1649537267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMPSON | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 WAGNER WAY NW STE 200 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983356904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6626 WAGNER WAY NW STE 200 | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 03/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LF60329266 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.