Provider Demographics
NPI:1942423603
Name:KUSTURIC, NATALIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:KUSTURIC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:KUSTURIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:716 SE 12TH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2094
Mailing Address - Country:US
Mailing Address - Phone:310-989-8595
Mailing Address - Fax:
Practice Address - Street 1:716 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2094
Practice Address - Country:US
Practice Address - Phone:561-316-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3190106H00000X
CAMFC39260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist