Provider Demographics
NPI:1265715874
Name:SPAIN, NATALIE NOEL
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NOEL
Last Name:SPAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CERRILLOS RD STE 207A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2695
Mailing Address - Country:US
Mailing Address - Phone:505-670-7728
Mailing Address - Fax:
Practice Address - Street 1:3600 CERRILLOS RD STE 207A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2695
Practice Address - Country:US
Practice Address - Phone:505-670-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health