Provider Demographics
NPI:1386275139
Name:SAMPLES, ZACK
Entity type:Individual
Prefix:
First Name:ZACK
Middle Name:
Last Name:SAMPLES
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 1:3602 SPERRY AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1036
Mailing Address - Country:US
Mailing Address - Phone:615-512-2789
Mailing Address - Fax:
Practice Address - Street 1:3602 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-1036
Practice Address - Country:US
Practice Address - Phone:615-512-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health