Provider Demographics
NPI:1194535559
Name:SAMANTHA LIN LEWIS, LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC
Entity type:Organization
Organization Name:SAMANTHA LIN LEWIS, LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:714-510-2705
Mailing Address - Street 1:PO BOX 10162
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-0962
Mailing Address - Country:US
Mailing Address - Phone:714-510-2705
Mailing Address - Fax:
Practice Address - Street 1:11949 JEFFERSON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6336
Practice Address - Country:US
Practice Address - Phone:714-510-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty