=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649050261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASEY SAMOIS MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2023
-----------------------------------------------------
Last Update Date | 10/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4789 VINELAND AVE STE 205
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91602-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-770-6147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24307 MAGIC MOUNTAIN PKWY STE 310
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-265-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 158084
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------