Provider Demographics
NPI:1306281795
Name:SAMSON, REBECCA (MFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 AVIATION BLVD # 129
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2805
Mailing Address - Country:US
Mailing Address - Phone:310-491-6455
Mailing Address - Fax:
Practice Address - Street 1:1525 AVIATION BLVD # 129
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2805
Practice Address - Country:US
Practice Address - Phone:310-491-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist