Provider Demographics
NPI:1104244359
Name:USHER, SAMUEL S (LAADC CEAP)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:S
Last Name:USHER
Suffix:
Gender:M
Credentials:LAADC CEAP
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:USHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAADC CEAP
Mailing Address - Street 1:5724 STANSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-321-8637
Mailing Address - Fax:818-988-4183
Practice Address - Street 1:5724 STANSBURY AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2341
Practice Address - Country:US
Practice Address - Phone:818-321-8637
Practice Address - Fax:818-988-4183
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALNR5800311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)