Provider Demographics
NPI:1750663241
Name:INDRASARI, NATALIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:NATALIA
Middle Name:
Last Name:INDRASARI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 EP TRUE PKWY # 152
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7696
Mailing Address - Country:US
Mailing Address - Phone:515-505-3507
Mailing Address - Fax:515-207-9416
Practice Address - Street 1:3408 WOODLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6504
Practice Address - Country:US
Practice Address - Phone:515-267-1996
Practice Address - Fax:515-207-9416
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI175106H00000X
VA0717001225106H00000X
IA086495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist