Basic Information
| Provider Information | |||||||||
| NPI: | 1851438766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMURRAY | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | NICLOE | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 ESTUDILLO AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945774962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109240548 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2050 FAIRMONT DR | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945781001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104833030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2838 | CA | N | Behavioral Health & Social Service Providers | Counselor | 101YS0200X | 2838 | CA | N | Behavioral Health & Social Service Providers | Counselor | School | 106H00000X | LMFT105112 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.