Provider Demographics
NPI:1386984862
Name:MCDILL, SAM RUTHERFORD JR (PHD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:RUTHERFORD
Last Name:MCDILL
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-1031
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:661-823-3339
Practice Address - Street 1:END RTE 202
Practice Address - Street 2:TEHACHAPI
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-3561
Practice Address - Country:US
Practice Address - Phone:661-822-4402
Practice Address - Fax:661-823-3339
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12096103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist