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General NPI Number Information
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NPI Number | 1285147884
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Entity Type | Individual
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Provider Name | SAMANTHA LAUREN POTTHOFF LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 127 BROADWAY STE 205
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City | SANTA MONICA
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State | CA
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Zip | 90401-2330
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Country | US
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Telephone | 310-925-3357
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Fax |
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Provider Business Mailing Address
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Address Line | 14431 VENTURA BLVD # 259
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2606
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Country | US
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Telephone | 310-925-3357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 119290
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 102247
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License Number State | CA
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