Provider Demographics
NPI:1245074863
Name:DU, NATHALIE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 INDIANA AVE STE 175
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4248
Mailing Address - Country:US
Mailing Address - Phone:951-346-0069
Mailing Address - Fax:951-547-1634
Practice Address - Street 1:6700 INDIANA AVE STE 175
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4248
Practice Address - Country:US
Practice Address - Phone:951-346-0069
Practice Address - Fax:951-547-1634
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT139712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist