Basic Information
| Provider Information | |||||||||
| NPI: | 1487946604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAUSWALD | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | TYLER | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 CHILENO VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | PETALUMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949529501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077817115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 E GOBBI ST | ||||||||
| Address2: | |||||||||
| City: | UKIAH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954825511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074672010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 66286 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.