Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Addiction (Substance Use Disorder) |
101YA0400X | |||
Prescribing (Medical) |
103TP0016X | 62 | Psychologist, Clinical |
| NPI Number | 1538342829 |
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| LBN Legal business name | WALTER VAN SAMBECK | ||||||||||||||||
| Authorized official | WALTER VAN SAMBECK - (OWNER) | ||||||||||||||||
| Entity | Organization | ||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||
| Enumeration date | 12/10/2007 | ||||||||||||||||
| Last updated | 06/16/2008 - About 18 years ago | ||||||||||||||||
| Identifiers |
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