Provider Demographics
NPI:1982123881
Name:WORSSAM, SAMI LYN STORY (PHD, ARIZONA LICENSE)
Entity type:Individual
Prefix:
First Name:SAMI LYN
Middle Name:STORY
Last Name:WORSSAM
Suffix:
Gender:F
Credentials:PHD, ARIZONA LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROCKY RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-9132
Mailing Address - Country:US
Mailing Address - Phone:928-567-8000
Mailing Address - Fax:928-567-8063
Practice Address - Street 1:125 ROCKY RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-9132
Practice Address - Country:US
Practice Address - Phone:928-567-8000
Practice Address - Fax:928-567-8063
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4882103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist