Provider Demographics
NPI:1437298627
Name:NORDMARKEN, NOLA (MFT)
Entity type:Individual
Prefix:
First Name:NOLA
Middle Name:
Last Name:NORDMARKEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3227
Mailing Address - Country:US
Mailing Address - Phone:310-573-9645
Mailing Address - Fax:310-573-9645
Practice Address - Street 1:3301 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3227
Practice Address - Country:US
Practice Address - Phone:310-573-9645
Practice Address - Fax:310-573-9645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist