Healthcare Provider Details

I. General information

NPI: 1770601072
Provider Name (Legal Business Name): IDELL FREED NATTERSON PHD MFT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S MCCARTY DR
BEVERLY HILLS CA
90212
US

IV. Provider business mailing address

300 S MCCARTY DR
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-1087
  • Fax: 310-277-0294
Mailing address:
  • Phone: 310-277-1087
  • Fax: 310-277-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLCSW1365
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT14830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: