MEDICARE: NATHALIA M PALIS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF67201	CA
2	106H00000X	Marriage & Family Therapist	LMFT104085	CA

General Provider Information

NPI Number	:	1154661460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIA M PALIS LMFT

Provider Business Mailing Address
First Line	:	24979 CONSTITUTION AVE APT 1125
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-1746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	27200 TOURNEY RD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-4990
Country	:	US
Telephone Number	:	661-537-5008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	02/01/2018

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