MEDICARE: NATALIE AMBRIZ B.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	15-219-0880	CO

General Provider Information

NPI Number	:	1508224270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE AMBRIZ B.A

Provider Business Mailing Address
First Line	:	22959 E SMOKY HILL RD APT H102
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-6726
Country	:	US
Telephone Number	:	575-915-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	22959 E SMOKY HILL RD APT H102
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-6726
Country	:	US
Telephone Number	:	575-915-4336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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