Healthcare Provider Details

I. General information

NPI: 1013462621
Provider Name (Legal Business Name): NATASHA KHOURY M.A., M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA KHOURY LMHC

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 22ND AVE
SAN FRANCISCO CA
94122-4421
US

IV. Provider business mailing address

1823 22ND AVE
SAN FRANCISCO CA
94122-4421
US

V. Phone/Fax

Practice location:
  • Phone: 610-322-3164
  • Fax:
Mailing address:
  • Phone: 610-322-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12098
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: