Healthcare Provider Details

I. General information

NPI: 1336739937
Provider Name (Legal Business Name): RICHARD E. NASEF MS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BONITO CT
SANTA FE NM
87508-8311
US

IV. Provider business mailing address

10 BONITO CT
SANTA FE NM
87508-8311
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-6413
  • Fax:
Mailing address:
  • Phone: 310-316-6413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT25725
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF0067452
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: