Healthcare Provider Details

I. General information

NPI: 1063080398
Provider Name (Legal Business Name): NATALIE BJORNSTAD LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 310
GILBERT AZ
85295-3215
US

IV. Provider business mailing address

1760 E PECOS RD
GILBERT AZ
85295-3200
US

V. Phone/Fax

Practice location:
  • Phone: 480-530-0840
  • Fax:
Mailing address:
  • Phone: 480-530-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-10444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: