Provider Demographics
NPI:1134335680
Name:SAMUEL-CATO, JACQUELINE DIANE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DIANE
Last Name:SAMUEL-CATO
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:PO BOX 35523
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-0523
Mailing Address - Country:US
Mailing Address - Phone:213-630-3061
Mailing Address - Fax:323-938-1430
Practice Address - Street 1:3660 WILSHIRE BLVD
Practice Address - Street 2:SUITE #907
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2756
Practice Address - Country:US
Practice Address - Phone:213-388-6668
Practice Address - Fax:323-938-1430
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist