Provider Demographics
NPI:1598023335
Name:RICHARDSON, NATASHA (MS)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9047 ARROW RTE STE 170
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4434
Mailing Address - Country:US
Mailing Address - Phone:909-466-8696
Mailing Address - Fax:
Practice Address - Street 1:9047 ARROW RTE STE 170
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4434
Practice Address - Country:US
Practice Address - Phone:909-466-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist