Derrick Loren Sampson, MS, SUDT, MHP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO60749434 Issued in WA

Practice address

12201 Pacific Ave S
Tacoma, WA 98444-5126

Phone

(253) 536-6425

NPI assigned

Oct 24, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Prosperity Counseling & Treatment Services Inc.

  • Community/Behavioral Health Agency
  • Tacoma, WA
  • NPI 1750821781
  NPD (past)

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1679040901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 112TH ST E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984465307",
            "telephone_number": "253-536-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 PACIFIC AVE S",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984445126",
            "telephone_number": "253-536-6425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "DERRICK",
        "middle_name": "LOREN",
        "credential": "MS, SUDT, MHP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-24",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60749434",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CG60832062",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hembashima Gabriel Sambe, MD, MPH
• Sandi Sambrano, N.D.
• Stephen Lee Sammons
• Linda Rosa Samora
• Catherine M Sampert, DO, MS
• Jennifer Maria Sampson, PH.D., LMFT
• Michael Todd Sams, MPT, OCS
• Kelsey Monroe Samuelson, RN
• Shaelene San Nicolas-Cruz
• Wesley San, MD

• Addiction (Substance Use Disorder) Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.