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General NPI Number Information
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NPI Number | 1346975653
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Entity Type | Individual
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Provider Name | SAMANTHA BROOKE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 11303 WILSHIRE BLVD BLDG 116
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City | LOS ANGELES
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State | CA
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Zip | 90025-5069
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Country | US
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Telephone | 310-914-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 10599 WILSHIRE BLVD APT 311C
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City | LOS ANGELES
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State | CA
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Zip | 90024-7624
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Country | US
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Telephone | 951-490-1749
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19204
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License Number State | CA
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