Healthcare Provider Details

I. General information

NPI: 1649537267
Provider Name (Legal Business Name): MR. NEIL M SAMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9013 KEY PENINSULA HWY NW
LAKEBAY WA
98349-8518
US

IV. Provider business mailing address

9013 KEY PENINSULA HWY NW
LAKEBAY WA
98349-8518
US

V. Phone/Fax

Practice location:
  • Phone: 253-220-7833
  • Fax:
Mailing address:
  • Phone: 253-220-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60329266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: