Provider Demographics
NPI:1699363259
Name:NATEVA MENTAL HEALTH
Entity Type:Organization
Organization Name:NATEVA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC,NCC
Authorized Official - Phone:773-830-4321
Mailing Address - Street 1:1639 N KEYSTONE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-5239
Mailing Address - Country:US
Mailing Address - Phone:773-830-4321
Mailing Address - Fax:
Practice Address - Street 1:1639 N KEYSTONE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5239
Practice Address - Country:US
Practice Address - Phone:773-830-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty