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SHANNON L SAMPLES TBS COORDINATOR
>> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1316087307
Individual Registrant: SHANNON L SAMPLES TBS COORDINATOR
Gender: F
Not Sole Proprietor
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
Tel: 707-275-8166 Fax: 707-275-8168
Contact information for business:
8357 SADDLE RD KELSEYVILLE, CA 95451-7847 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1316087307
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101Y00000X | Behavioral Health & Social Service Providers Counselor |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
