NPIMap

Organization Active NPI

Samuel T. Enterprise

  • Mental Health Counselor
  • Costa Mesa, CA
National Provider Identifier
1194194860
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SAMUEL T. ENTERPRISE
Doing business as
LifeLine Health Solutions
Practice address
3151 Airway Ave
Suite D2
Costa Mesa, CA 92626-4607
Phone
(714) 847-7585
Fax
(714) 848-5410
NPI assigned
Sep 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

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

Authorized official

Name
Mrs. Linda Jean Tesoro, MFT
Title
Administrator
Phone
(714) 847-7585

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X

Addresses

Primary practice location

3151 Airway Ave
Suite D2
Costa Mesa, CA 92626-4607

Mailing address

3151 Airway Ave
Suite D2
Costa Mesa, CA 92626-4607
Phone (714) 847-7585

Other names 1

  • LifeLine Health Solutions Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1194194860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE",
            "address_2": "SUITE D2",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264607",
            "telephone_number": "714-847-7585",
            "fax_number": "714-848-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE",
            "address_2": "SUITE D2",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264607",
            "telephone_number": "714-847-7585",
            "fax_number": "714-848-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL T. ENTERPRISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "TESORO",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-847-7585",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeLine Health Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.