Provider Demographics
NPI:1285011445
Name:POTYAGOVA, NATALIE (LMFT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:POTYAGOVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19634 VENTURA BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6022
Mailing Address - Country:US
Mailing Address - Phone:818-399-4776
Mailing Address - Fax:
Practice Address - Street 1:19634 VENTURA BLVD STE 303
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6022
Practice Address - Country:US
Practice Address - Phone:818-399-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist