Provider Demographics
NPI:1639385578
Name:SAMPSON, JENNIFER MARIA (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIA
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIA
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LMFT
Mailing Address - Street 1:5702 N 26TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2406
Mailing Address - Country:US
Mailing Address - Phone:253-292-1216
Mailing Address - Fax:253-265-4950
Practice Address - Street 1:5702 N 26TH ST STE B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2406
Practice Address - Country:US
Practice Address - Phone:253-292-1216
Practice Address - Fax:253-265-4950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60230886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist