Provider Demographics
NPI:1295035715
Name:LAU, NATASHA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:LAU - JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:8344 JO MARCY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4601
Mailing Address - Country:US
Mailing Address - Phone:702-375-3387
Mailing Address - Fax:
Practice Address - Street 1:3606 N RANCHO DR STE 142
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3130
Practice Address - Country:US
Practice Address - Phone:702-375-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
NVMI0891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health