Provider Demographics
NPI:1861071144
Name:SURIC, NATALIE ISABELLA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ISABELLA
Last Name:SURIC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7677 CENTER AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3098
Mailing Address - Country:US
Mailing Address - Phone:949-565-4733
Mailing Address - Fax:
Practice Address - Street 1:1434 BRETT PL UNIT 67
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-5140
Practice Address - Country:US
Practice Address - Phone:310-480-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT122012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist