Healthcare Provider Details

I. General information

NPI: 1417701434
Provider Name (Legal Business Name): SAMANTHA SEATON MARRIAGE AND FAMILY THERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14751 PLAZA DR STE E
TUSTIN CA
92780-2773
US

IV. Provider business mailing address

13791 PASADENA ST
SANTA ANA CA
92705-7925
US

V. Phone/Fax

Practice location:
  • Phone: 949-310-9617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SEATON DINO
Title or Position: OWNER/ OPERATOR
Credential: LMFT
Phone: 949-310-9627