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General NPI Number Information
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NPI Number | 1366952079
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Entity Type | Individual
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Provider Name | NATALIE LANAE FISH
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Gender | Female
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Dates
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Enumeration Date | 10/08/2017
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 5870 ARLINGTON AVE # 103
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City | RIVERSIDE
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State | CA
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Zip | 92504-2037
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Country | US
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Telephone | 951-683-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 10531 POLAND PL
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City | BANNING
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State | CA
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Zip | 92220-1561
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Country | US
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Telephone | 951-206-1173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8753-R
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 198753
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License Number State | CA
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