Provider Demographics
NPI:1285147884
Name:POTTHOFF, SAMANTHA LAUREN (LMFT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:POTTHOFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LAUREN
Other - Last Name:CHAIKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:14431 VENTURA BLVD # 259
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2606
Mailing Address - Country:US
Mailing Address - Phone:310-925-3357
Mailing Address - Fax:
Practice Address - Street 1:127 BROADWAY STE 205
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2330
Practice Address - Country:US
Practice Address - Phone:310-925-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119290106H00000X
CA102247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist