Provider Demographics
NPI:1346818630
Name:KOMASHKO-TANGNER, NATALIE (LMFT,CDS,PPS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KOMASHKO-TANGNER
Suffix:
Gender:F
Credentials:LMFT,CDS,PPS
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:KOMASHKO-TANGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TANGNER
Mailing Address - Street 1:4110 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-8409
Mailing Address - Country:US
Mailing Address - Phone:805-750-3581
Mailing Address - Fax:
Practice Address - Street 1:5738 MAMMOTH AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4417
Practice Address - Country:US
Practice Address - Phone:805-750-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist