Provider Demographics
NPI:1679001309
Name:BERLIN, NATALIE (LPC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10138 CARLSBAD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3427
Mailing Address - Country:US
Mailing Address - Phone:318-393-9810
Mailing Address - Fax:
Practice Address - Street 1:8504 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6146
Practice Address - Country:US
Practice Address - Phone:318-868-2001
Practice Address - Fax:318-675-1517
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional