Provider Demographics
NPI:1922874338
Name:LAND, NATALIE (MS, LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:MS, LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 CALMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5317
Mailing Address - Country:US
Mailing Address - Phone:214-415-2613
Mailing Address - Fax:
Practice Address - Street 1:4928 CALMONT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5317
Practice Address - Country:US
Practice Address - Phone:214-415-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist