Provider Demographics
NPI:1912548439
Name:SAMMADI, TINA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:SAMMADI
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 1:1220 MANNING AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5078
Mailing Address - Country:US
Mailing Address - Phone:310-401-3355
Mailing Address - Fax:
Practice Address - Street 1:15611 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3128
Practice Address - Country:US
Practice Address - Phone:310-401-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist