| |
5702 N 26th St Ste B Tacoma WA 98407-2406 | |
(253) 292-1216 | |
(253) 265-4950 |
Full Name | |
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Speciality | Marriage & Family Therapist |
Location | 5702 N 26th St Ste B, Tacoma, Washington |
Authorized Official Name and Position | Jennifer Sampson (OWNER) |
Authorized Official Contact | 2532921216 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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5702 N 26th St Ste B Tacoma WA 98407-2406 Ph: (253) 292-1216 | 5702 N 26th St Ste B Tacoma WA 98407-2406 Ph: (253) 292-1216 |
NPI Number | 1063840791 |
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Provider Enumeration Date | 10/15/2013 |
Last Update Date | 09/17/2024 |
Certification Date | 09/17/2024 |
Medicare PECOS PAC ID | 6305060948 |
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Medicare Enrollment ID | O20140620001978 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063840791 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | 603337603 (Washington) | Primary |
Provider Name | Jennifer Maria Sampson-susag |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1639385578 PECOS PAC ID: 7012131667 Enrollment ID: I20240611003957 |
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