Samantha Sewell Short, PSYD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

15-11P Issued in AR

Practice address

317 Oak St Ste 3
Conway, AR 72032-5679

Phone

(501) 358-6396

Fax

(501) 588-0484

NPI assigned

Dec 5, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Samantha Nicole Robinson Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Therapy Assessment Center LLCGroup PAC ID 0941538557, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapy Assessment Center, LLC

  • Group Psychotherapy Psychologist
  • Conway, AR
  • NPI 1093184210
  Medicare reassignment Care Compare group Authorized official
• Therapy Assessment Center LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Conway, AR
  • NPI 1487492153
  NPD Authorized official
• Therapy Assessment Center LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Conway, AR
  • NPI 1629800099
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1144465139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 OAK ST STE 3",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720325679",
            "telephone_number": "501-291-3091",
            "fax_number": "501-588-0484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 OAK ST STE 3",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720325679",
            "telephone_number": "501-358-6396",
            "fax_number": "501-588-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "SAMANTHA",
        "middle_name": "SEWELL",
        "name_prefix": "Ms.",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-05",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "15-11P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "ROBINSON",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexa Shipp, APRN
• Kara Charles Shipp, PD
• Brandon Deontae Shirlee
• Carol Jean Shirley
• David Craig Shirley, M.D.
• Tamara J Short
• Catherine L Shourd, OTRL
• Kathryn Shouse, OT
• Cynthia Shuffield
• Charles Sibley

• Clinical Psychologist in Conway, AR
• Providers in Conway, AR by specialty
• Clinical Psychologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.