Healthcare Provider Details

I. General information

NPI: 1861953408
Provider Name (Legal Business Name): CHELSEA NATY FOMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date: 08/25/2024
Reactivation Date: 09/24/2024

III. Provider practice location address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

V. Phone/Fax

Practice location:
  • Phone: 323-536-2203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT142757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: