Provider Demographics
NPI:1225656788
Name:SAMS, DARBY MERCEDES
Entity type:Individual
Prefix:MRS
First Name:DARBY
Middle Name:MERCEDES
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DARBY
Other - Middle Name:MERCEDES
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9812 TWIN MILL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-4868
Mailing Address - Country:US
Mailing Address - Phone:702-672-7079
Mailing Address - Fax:
Practice Address - Street 1:5980 S DURANGO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-672-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-21-151725106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician