Individual
SAMUEL STAGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED
Contact information
Practice address
513 MADISON AVE, COVINGTON, KY 41011-1562
(859) 331-3292
(859) 578-2864
Mailing address
502 FARRELL DR, COVINGTON, KY 41011-3717
(859) 578-3204
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
164155
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
KY
Enumeration date
01/11/2012
Last updated
08/10/2016
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