Samelson, Jeffrey

Samelson, Jeffrey is an individual health care provider with primary practice located at 104 Woodland Ct Ste B , Michigan City IN 46360-7391. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Samelson, Jeffrey can be contacted via phone (219) 628-6463.

Contact Information

Primary practice address
104 Woodland Ct Ste B Michigan City IN 46360-7391
Phone: (219) 628-6463
Fax: (219) 628-6463
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 20010303A Indiana
Behavioral Health & Social Service Providers / Clinical 103TC0700X 20010303A Indiana

Profile Details

NPI number 1801866223
LBN Legal business name Samelson, Jeffrey
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Mar 7th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801866223 NPPES
Indiana MEDICAID 100162900
Indiana Other P00616032
Indiana Other 000000347073

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