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General NPI Number Information
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NPI Number | 1194535559
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Entity Type | Organization
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Legal Business Name | SAMANTHA LIN LEWIS, LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 11949 JEFFERSON BLVD STE 102
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City | CULVER CITY
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State | CA
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Zip | 90230-6336
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Country | US
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Telephone | 714-510-2705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10162
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City | TORRANCE
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State | CA
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Zip | 90505-0962
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Country | US
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Telephone | 714-510-2705
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMANTHA LIN LEWIS
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Credential | MA, LPCC
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Telephone | 714-510-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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