Provider Demographics
NPI:1548887060
Name:WESSELS, SAMUEL PHILIP
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PHILIP
Last Name:WESSELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4003
Mailing Address - Country:US
Mailing Address - Phone:925-471-5967
Mailing Address - Fax:
Practice Address - Street 1:100 BUSH ST STE 1428
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3916
Practice Address - Country:US
Practice Address - Phone:415-843-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist