Provider Demographics
NPI:1275804221
Name:FORDHAM, NATHAN LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:LEE
Last Name:FORDHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-4179
Mailing Address - Fax:541-574-6252
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4196
Practice Address - Fax:541-994-1882
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORC3541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)