Healthcare Provider Details

I. General information

NPI: 1609566231
Provider Name (Legal Business Name): NATALIE JEAN HOLMGREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE FRITTS

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151-6153 W OLIVE AVE
GLENDALE AZ
85302-4598
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 400
PHOENIX AZ
85012-2929
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-6000
  • Fax: 602-389-3599
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-302-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20985
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: