Provider Demographics
NPI:1780100081
Name:SAMUELS, AMISHA PATEL (LMFT)
Entity type:Individual
Prefix:
First Name:AMISHA
Middle Name:PATEL
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMISHA
Other - Middle Name:RAJESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48810 VIA MARINA
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2095 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3019
Practice Address - Country:US
Practice Address - Phone:760-416-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist