Provider Information for 1801042569
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LARA NATALIE JUSTICE LMFT
Sex: Female
NPI: 1801042569
Last Updated: 2014-01-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1801042569 | ||||||||
| Enumeration Date | 2008-08-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1891 EFFIE ST LOS ANGELES, CA 90026-1711 United States Phone: 213-587-3336 | Fax: | ||||||||
| Primary Practice Address | 118 CARR DR APT 104 GLENDALE, CA 91205-1546 United States Phone: 213-587-3336 | Fax: | ||||||||
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