Provider Demographics
NPI:1558844365
Name:COX, SAMANTHA (LMFT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N HARBOR BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1901
Mailing Address - Country:US
Mailing Address - Phone:562-631-8913
Mailing Address - Fax:
Practice Address - Street 1:305 N HARBOR BLVD STE 307
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1901
Practice Address - Country:US
Practice Address - Phone:562-631-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103644103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling