=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124541099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE ST. CYR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2017
-----------------------------------------------------
Last Update Date | 07/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2566 OVERLAND AVE STE 500B
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90064-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-284-9339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8544 BURTON WAY APT 305
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-3389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-279-2672
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT99004
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------