Healthcare Provider Details

I. General information

NPI: 1285147884
Provider Name (Legal Business Name): SAMANTHA LAUREN POTTHOFF LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA LAUREN CHAIKIN LMFT

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N SAN VICENTE BLVD STE 256
BEVERLY HILLS CA
90211-2329
US

IV. Provider business mailing address

113 N SAN VICENTE BLVD STE 256
BEVERLY HILLS CA
90211-2329
US

V. Phone/Fax

Practice location:
  • Phone: 310-925-3357
  • Fax:
Mailing address:
  • Phone: 310-925-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: