Healthcare Provider Details

I. General information

NPI: 1831481944
Provider Name (Legal Business Name): NATASHA E. WALTER-FISK LPCC, LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 19TH AVE
SAN FRANCISCO CA
94121-3829
US

IV. Provider business mailing address

3707 GRAND WAY APT 313
ST LOUIS PARK MN
55416-2754
US

V. Phone/Fax

Practice location:
  • Phone: 415-806-7977
  • Fax:
Mailing address:
  • Phone: 415-806-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT.47582
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0005742
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.2624
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: