Provider Demographics
NPI:1699218891
Name:AMBROSE, NATALIE (MA, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-5913
Mailing Address - Country:US
Mailing Address - Phone:504-218-3731
Mailing Address - Fax:
Practice Address - Street 1:1529 RIVER OAKS RD W
Practice Address - Street 2:SUITE 119
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2162
Practice Address - Country:US
Practice Address - Phone:504-218-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional