Natalia Indrasari, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

086495 Issued in IA

Practice address

3408 Woodland Ave Ste 102
West Des Moines, IA 50266-6504

Phone

(515) 267-1996

Fax

(515) 207-9416

NPI assigned

Sep 12, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1750663241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3775 EP TRUE PKWY # 152",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502657696",
            "telephone_number": "515-505-3507",
            "fax_number": "515-207-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 WOODLAND AVE STE 102",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666504",
            "telephone_number": "515-267-1996",
            "fax_number": "515-207-9416"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3020 Javier Rd",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314609",
            "country_code": "US",
            "telephone_number": "703-628-7279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INDRASARI",
        "first_name": "NATALIA",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-12",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "HI",
            "license": "175",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "VA",
            "license": "0717001225",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IA",
            "license": "086495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Marriage & Family Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.