Provider Demographics
NPI:1649060716
Name:LEFEBRE, NATHAN MICHAEL (MA)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:MICHAEL
Last Name:LEFEBRE
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 N MADISON AVE APT 429
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4467
Mailing Address - Country:US
Mailing Address - Phone:616-745-4944
Mailing Address - Fax:
Practice Address - Street 1:150 W SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2435
Practice Address - Country:US
Practice Address - Phone:626-470-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027254103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical