Provider Demographics
NPI:1700420551
Name:NAVARRE GIRAULT, NICOLE SUZANNE (JD, MA, AMFT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SUZANNE
Last Name:NAVARRE GIRAULT
Suffix:
Gender:F
Credentials:JD, MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 S BUNDY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7706
Mailing Address - Country:US
Mailing Address - Phone:314-239-4206
Mailing Address - Fax:
Practice Address - Street 1:9350 WILSHIRE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3204
Practice Address - Country:US
Practice Address - Phone:310-271-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist