Provider Demographics
NPI:1356639660
Name:BAILEY, NATASHA ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ANN
Last Name:BAILEY
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 1:3344 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5704
Mailing Address - Country:US
Mailing Address - Phone:619-370-1714
Mailing Address - Fax:619-293-3275
Practice Address - Street 1:3344 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5704
Practice Address - Country:US
Practice Address - Phone:619-370-1714
Practice Address - Fax:619-293-3275
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist