Kimally L. Samuels, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

44594 Issued in CA

Practice address

2225 Buchanan Rd Ste H
Antioch, CA 94509-4209

Phone

(925) 226-8780

Fax

(925) 777-9446

NPI assigned

Nov 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Kimally L. Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Compassionate Heart Counseling

  • Marriage & Family Therapist
  • Antioch, CA
  • NPI 1861077612
  NPD Authorized official

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1508047051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 BAILEY RD # 482",
            "city": "BAY POINT",
            "state": "CA",
            "postal_code": "945654306",
            "telephone_number": "925-226-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 BUCHANAN RD STE H",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094209",
            "telephone_number": "925-226-8780",
            "fax_number": "925-777-9446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 Fairmont Dr",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945781001",
            "country_code": "US",
            "telephone_number": "510-483-3030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "KIMALLY",
        "middle_name": "L.",
        "name_prefix": "Miss",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-26",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "44594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMALLY",
            "last_name": "JACKSON",
            "middle_name": "L.",
            "prefix": "MISS",
            "credential": "MFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Arielle Marie Samuels, LVN
• Rodrigo Sanchez-Pinelo
• Chrissondra Renee Sanchez
• Claudia Lorena Sanchez
• Edgard H. Sanchez, MD
• John Sanchez, PTA

• Marriage & Family Therapist in Antioch, CA
• Providers in Antioch, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.