Provider Demographics
NPI:1679943526
Name:SAMPLES, SVETLANA (MFTI)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:I
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:9730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 216C
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9730 WILSHIRE BLVD
Practice Address - Street 2:SUITE 216C
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2022
Practice Address - Country:US
Practice Address - Phone:310-715-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF82109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health