Provider Demographics
NPI:1407181316
Name:NICOLE GERTH
Entity Type:Organization
Organization Name:NICOLE GERTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-922-2476
Mailing Address - Street 1:30011 IVY GLENN DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5014
Mailing Address - Country:US
Mailing Address - Phone:949-922-2476
Mailing Address - Fax:
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE 221
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-922-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47189251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health