Provider Demographics
NPI:1518411958
Name:KAZAKOVA, NATALIA (MS, PSYD)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:KAZAKOVA
Suffix:
Gender:F
Credentials:MS, PSYD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:KAZAKOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PSYD
Mailing Address - Street 1:1616 N CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11221 N 28TH DRIVE BUILDING E
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4218
Practice Address - Country:US
Practice Address - Phone:602-316-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005610103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty