Provider Demographics
NPI:1861919185
Name:NATOSHA A. PENA, LPC, LCC
Entity type:Organization
Organization Name:NATOSHA A. PENA, LPC, LCC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:504-717-8592
Mailing Address - Street 1:2115 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5920
Mailing Address - Country:US
Mailing Address - Phone:504-717-8592
Mailing Address - Fax:
Practice Address - Street 1:7807 AIRLINE DR STE 210
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6437
Practice Address - Country:US
Practice Address - Phone:504-717-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty