Provider Demographics
NPI:1851860613
Name:PEDERSEN, NIKKI LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LYNN
Other - Last Name:VANDERGRIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6635 FLORENCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4968
Mailing Address - Country:US
Mailing Address - Phone:323-647-6740
Mailing Address - Fax:
Practice Address - Street 1:6635 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4968
Practice Address - Country:US
Practice Address - Phone:323-647-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist