1629107453 NPI number — MRS. DEE ANN MCLELLAN-SAMS LCPC, LAC, CAMS II

Table of content: MRS. DEE ANN MCLELLAN-SAMS LCPC, LAC, CAMS II (NPI 1629107453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629107453 NPI number — MRS. DEE ANN MCLELLAN-SAMS LCPC, LAC, CAMS II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLELLAN-SAMS
Provider First Name:
DEE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, LAC, CAMS II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLELLAN
Provider Other First Name:
DEE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC, LAC, CAMS II
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629107453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 MAIN ST.
Provider Second Line Business Mailing Address:
CHOICES-COMPASSIONATE CARE COUNSELING CENTER
Provider Business Mailing Address City Name:
MILES CITY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-951-0308
Provider Business Mailing Address Fax Number:
406-234-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2705 MAIN ST
Provider Second Line Business Practice Location Address:
CHOICES-COMPASSIONATE CARE COUNSELING CENTER
Provider Business Practice Location Address City Name:
MILES CITY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-951-0308
Provider Business Practice Location Address Fax Number:
406-234-2692
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  455 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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