Provider Demographics
NPI:1093282592
Name:MAUST, NATHAN GREGORY (LCPC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:GREGORY
Last Name:MAUST
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-0055
Mailing Address - Country:US
Mailing Address - Phone:301-450-7274
Mailing Address - Fax:301-238-8044
Practice Address - Street 1:3231 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1370
Practice Address - Country:US
Practice Address - Phone:301-450-7274
Practice Address - Fax:301-238-8044
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8709101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor