Provider Demographics
NPI:1588376289
Name:PEPPERCORN, NATALIE LYNN (MFTC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNN
Last Name:PEPPERCORN
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 S ELATI ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-1443
Mailing Address - Country:US
Mailing Address - Phone:303-522-3715
Mailing Address - Fax:
Practice Address - Street 1:8774 YATES DR STE 135
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6966
Practice Address - Country:US
Practice Address - Phone:720-738-4829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014404106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMFTC.0014404OtherMARRIAGE AND FAMILY THERAPY CANDIDACY LICENSE