Provider Demographics
NPI:1710371778
Name:ASAWESNA, NATALIE (LMFT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ASAWESNA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7717
Mailing Address - Country:US
Mailing Address - Phone:562-507-1751
Mailing Address - Fax:562-296-6452
Practice Address - Street 1:250 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7717
Practice Address - Country:US
Practice Address - Phone:562-507-1751
Practice Address - Fax:562-296-6452
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98534106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist