Doctor Name: | MS. NATASHA N. NICHOLS |
NPI Number: | 1053518043 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MFTI |
License Number: | IMF53614 |
Business Practice Address: | 1107 S Glendora Ave West Covina, CA - 917904923 |
Business Phone Number: | 6268149085 |
Business Fax Number: | |
Mailing Address: | 1107 S Glendora Ave, WEST COVINA |
State: | CA |
Postal Code: | 917904923 |
Phone Number: | 6268149085 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMF53614 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |