Provider Demographics
NPI:1881252112
Name:BEAUMONT, SAMANTHA K (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SAMANTH
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 KAPIOLANI BLVD PH 60
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3518
Mailing Address - Country:US
Mailing Address - Phone:808-859-3331
Mailing Address - Fax:
Practice Address - Street 1:1221 KAPIOLANI BLVD PH 60
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3518
Practice Address - Country:US
Practice Address - Phone:808-859-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
HIMFT-802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist