Provider Demographics
NPI:1306934138
Name:SAMSAMY, SHALA H
Entity type:Individual
Prefix:MRS
First Name:SHALA
Middle Name:H
Last Name:SAMSAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHAHLA
Other - Middle Name:HODJAT
Other - Last Name:SAMSAMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:815 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4735
Mailing Address - Country:US
Mailing Address - Phone:562-430-6372
Mailing Address - Fax:562-430-6372
Practice Address - Street 1:5500 E ATHERTON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4016
Practice Address - Country:US
Practice Address - Phone:562-493-1496
Practice Address - Fax:562-493-3753
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist