Provider Demographics
NPI:1083391254
Name:UNRUH, NATHAN DANIEL
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DANIEL
Last Name:UNRUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N FOX WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-1146
Mailing Address - Country:US
Mailing Address - Phone:580-551-9498
Mailing Address - Fax:
Practice Address - Street 1:520 POINTE PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0600
Practice Address - Country:US
Practice Address - Phone:885-782-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician