Provider Demographics
NPI:1326686502
Name:MILLER, SAMANTHA (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 WILSHIRE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4749
Mailing Address - Country:US
Mailing Address - Phone:323-577-9959
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4749
Practice Address - Country:US
Practice Address - Phone:323-577-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty