Provider Demographics
NPI:1518273390
Name:WINGERT, NATALIA F (LMFT)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:F
Last Name:WINGERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:NATALIA
Other - Middle Name:F
Other - Last Name:BALASUNDARAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1100 WILSHIRE BLVD
Mailing Address - Street 2:APT 2010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1916
Mailing Address - Country:US
Mailing Address - Phone:626-290-4112
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 215
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:626-290-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CALMFT 94337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)