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NPI Code Detail

MEDICARE: LIZA M SAMPSON B.S.

MEDICARE: LIZA M SAMPSON B.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1750407110
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZA M SAMPSON B.S.
Provider Business Mailing Address
First Line : 51A SEATON VALLEY PATH
Second Line :
City : PALM COAST
State : FL
Zip : 32164-5364
Country : US
Telephone Number : 386-236-1812
Fax Number :
Provider Business Practice Location Address
First Line : 1150 RED JOHN DR
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32124-1016
Country : US
Telephone Number : 386-236-1770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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Directions to “ LIZA M SAMPSON B.S.” Practice Location

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