Provider Demographics
NPI:1831739705
Name:THIES, NATALIE C (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:C
Last Name:THIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E FOOTHILL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2361
Mailing Address - Country:US
Mailing Address - Phone:626-701-4249
Mailing Address - Fax:626-737-6034
Practice Address - Street 1:41 E FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2361
Practice Address - Country:US
Practice Address - Phone:626-701-4249
Practice Address - Fax:626-737-6034
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA929111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92911OtherBBS