Provider Demographics
NPI:1285877621
Name:MURRY, NATALIE NICOLE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:MURRY
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:PO BOX 3786
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-7486
Mailing Address - Country:US
Mailing Address - Phone:562-373-4321
Mailing Address - Fax:
Practice Address - Street 1:50 W LEMON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5112
Practice Address - Country:US
Practice Address - Phone:310-227-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139559106H00000X
225400000X
CA115949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner