Provider Demographics
NPI:1831481944
Name:WALTER-FISK, NATASHA E (LPCC, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:E
Last Name:WALTER-FISK
Suffix:
Gender:F
Credentials:LPCC, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 GRAND WAY APT 313
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2754
Mailing Address - Country:US
Mailing Address - Phone:415-806-7977
Mailing Address - Fax:
Practice Address - Street 1:631 19TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3829
Practice Address - Country:US
Practice Address - Phone:415-806-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT.47582106H00000X
COLPC.0005742101YP2500X
MNLPCC.2624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional