Provider Demographics
NPI:1659012813
Name:BUDHATHOKI, SAMANA (MS)
Entity Type:Individual
Prefix:
First Name:SAMANA
Middle Name:
Last Name:BUDHATHOKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LINDEN AVE APT 951
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4935
Mailing Address - Country:US
Mailing Address - Phone:626-780-1057
Mailing Address - Fax:
Practice Address - Street 1:140 LINDEN AVE APT 951
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4935
Practice Address - Country:US
Practice Address - Phone:626-780-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-04
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist