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SHANNON L SAMPLES TBS COORDINATOR

>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1316087307

Individual Registrant:
 SHANNON L SAMPLES TBS COORDINATOR
Gender: F
Not Sole Proprietor

Location and contact information for practice:
9860 MIDDLE CREEK RD  UPPER LAKE, CA 95485-9265 US
Tel: 707-275-8166  Fax: 707-275-8168

Contact information for business:
8357 SADDLE RD  KELSEYVILLE, CA 95451-7847 US
Tel: --  Fax: --

Registration Information:
NPI: 1316087307
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers
Counselor

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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