Provider Demographics
NPI:1306153424
Name:WASFI, SAMEH
Entity type:Individual
Prefix:
First Name:SAMEH
Middle Name:
Last Name:WASFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:WASFI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:21381 FALKIRK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8033
Mailing Address - Country:US
Mailing Address - Phone:714-757-7957
Mailing Address - Fax:
Practice Address - Street 1:21381 FALKIRK LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8033
Practice Address - Country:US
Practice Address - Phone:949-954-0756
Practice Address - Fax:949-242-2889
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96157106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist