Provider Demographics
NPI:1629396668
Name:SHAMLOU, SAMIRA (MA,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SAMIRA
Middle Name:
Last Name:SHAMLOU
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13662 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3334
Mailing Address - Country:US
Mailing Address - Phone:949-537-6365
Mailing Address - Fax:
Practice Address - Street 1:13662 WILSON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3334
Practice Address - Country:US
Practice Address - Phone:949-537-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT87618106H00000X
CANMFT INTERN 60251225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist