Provider Demographics
NPI:1508224270
Name:AMBRIZ, NATALIE (BA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:AMBRIZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22959 E SMOKY HILL RD APT H102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6726
Mailing Address - Country:US
Mailing Address - Phone:575-915-4336
Mailing Address - Fax:
Practice Address - Street 1:22959 E SMOKY HILL RD APT H102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-6726
Practice Address - Country:US
Practice Address - Phone:575-915-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15-219-0880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health