Provider Demographics
NPI:1114461209
Name:MAJOR, SAMUEL LAIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LAIS
Last Name:MAJOR
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398161
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-8161
Mailing Address - Country:US
Mailing Address - Phone:651-434-2166
Mailing Address - Fax:651-927-0233
Practice Address - Street 1:7201 YORK AVE S APT 1220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4447
Practice Address - Country:US
Practice Address - Phone:651-434-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist