Provider Demographics
NPI:1043001084
Name:SAMANTHA SEVERIN FAMILY THERAPY
Entity type:Organization
Organization Name:SAMANTHA SEVERIN FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-533-1374
Mailing Address - Street 1:6152 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2409
Mailing Address - Country:US
Mailing Address - Phone:949-533-1374
Mailing Address - Fax:
Practice Address - Street 1:1501 WESTCLIFF DR STE 290
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5517
Practice Address - Country:US
Practice Address - Phone:949-386-7178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty