Provider Demographics
NPI:1932546488
Name:NATALYA FATEYEVA PA
Entity type:Organization
Organization Name:NATALYA FATEYEVA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATEYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:954-707-8520
Mailing Address - Street 1:2159 NW 76THTERRACE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-707-8520
Mailing Address - Fax:
Practice Address - Street 1:7450 GRIFFIN RD STE 250
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4104
Practice Address - Country:US
Practice Address - Phone:954-707-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty