Healthcare Provider Details

I. General information

NPI: 1629740741
Provider Name (Legal Business Name): ROBERT JAMES SAMP III LPC, CMPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROB SAMP LPC

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W INSTITUTE PL STE 500
CHICAGO IL
60610-8792
US

IV. Provider business mailing address

213 W INSTITUTE PL STE 500
CHICAGO IL
60610-8792
US

V. Phone/Fax

Practice location:
  • Phone: 708-274-7870
  • Fax: 217-207-0347
Mailing address:
  • Phone: 708-274-7870
  • Fax: 217-207-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018240
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12682-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: