Healthcare Provider Details

I. General information

NPI: 1801001151
Provider Name (Legal Business Name): HARRY (SAM) WELLS SAPPINGTON III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAM H.W. SAPPINGTON PH.D.

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SW MADISON AVE. SUITE #107
CORVALLIS OR
97333-4728
US

IV. Provider business mailing address

4877 NW SOX LN
ALBANY OR
97321-9370
US

V. Phone/Fax

Practice location:
  • Phone: 541-602-4369
  • Fax: 541-368-4325
Mailing address:
  • Phone: 541-928-7556
  • Fax: 541-928-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1449
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1449
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: