Individual provider Active NPI

Samantha Bobbie Levesque, AMFT, APCC

  • Marriage & Family Therapist
  • Grand Terrace, CA
National Provider Identifier
1043163025
Registry record updated Feb 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
159655 Issued in CA
Practice address
12139 Mount Vernon Ave Ste 210
Grand Terrace, CA 92313-5562
Phone
(909) 577-1124
NPI assigned
Feb 18, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 20855 CA
Marriage & Family Therapist 106H00000X 159655 CA Primary

Addresses

Primary practice location

12139 Mount Vernon Ave Ste 210
Grand Terrace, CA 92313-5562

Mailing address

967 Kendall Dr Ste a
PMB 216
San Bernardino, CA 92407-4155

Other practice location 1

1400 E Cooley Dr # 200A
Colton, CA 92324-3939
Phone (909) 295-5295

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
159655CAMDMarriage & Family Therapist
20855CAMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1771372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1043163025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 KENDALL DR STE A",
            "address_2": "PMB 216",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 MOUNT VERNON AVE STE 210",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135562",
            "telephone_number": "909-577-1124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 E Cooley Dr # 200A",
            "address_purpose": "LOCATION",
            "city": "Colton",
            "state": "CA",
            "postal_code": "923243939",
            "country_code": "US",
            "telephone_number": "909-295-5295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEVESQUE",
        "first_name": "SAMANTHA",
        "middle_name": "BOBBIE",
        "credential": "AMFT, APCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-18",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "20855",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "159655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Terrace, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.