Provider Demographics
NPI:1750683421
Name:COLLINS-SMITH, NATALIE BERGEN (M,A, MFTI)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:BERGEN
Last Name:COLLINS-SMITH
Suffix:
Gender:F
Credentials:M,A, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7885 WHISPERING TRAILS PL
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6397
Mailing Address - Country:US
Mailing Address - Phone:805-610-4085
Mailing Address - Fax:
Practice Address - Street 1:856 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2918
Practice Address - Country:US
Practice Address - Phone:805-643-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINTERN #57898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist