Provider Demographics
NPI:1134506801
Name:NICOLE LABY, MFT
Entity Type:Organization
Organization Name:NICOLE LABY, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:KAT
Authorized Official - Last Name:LABY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:415-820-3952
Mailing Address - Street 1:2140 SHATTUCK AVE STE 603
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1227
Mailing Address - Country:US
Mailing Address - Phone:415-820-3952
Mailing Address - Fax:
Practice Address - Street 1:2140 SHATTUCK AVE STE 603
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1227
Practice Address - Country:US
Practice Address - Phone:415-820-3952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty