Provider Demographics
NPI:1073007977
Name:KRAUTHAMER, NICOLE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:KRAUTHAMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:KRAUTHAMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:11645 GORHAM AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4758
Mailing Address - Country:US
Mailing Address - Phone:310-292-4130
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD STE 381
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1660
Practice Address - Country:US
Practice Address - Phone:310-292-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist