Provider Demographics
NPI:1538864483
Name:SHEELEY, SAMANTHA LEIGH (LAC, NCC)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:SHEELEY
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 S LONGMORE UNIT 46
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5769
Mailing Address - Country:US
Mailing Address - Phone:319-360-3039
Mailing Address - Fax:
Practice Address - Street 1:1718 S LONGMORE UNIT 46
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5769
Practice Address - Country:US
Practice Address - Phone:319-360-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20831101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty