Basic Information
| Provider Information | |||||||||
| NPI: | 1205285533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCANELLEY-BODDIE | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | CARDELIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 W AVENUE J | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935343443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619490131 | ||||||||
| FaxNumber: | 6617298912 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 W AVENUE J | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935343443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619490131 | ||||||||
| FaxNumber: | 6617298912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2016 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMFT81419 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | AMFT81419 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | AMFT119733 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | LMFT122290 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.