Provider Demographics
NPI:1326420845
Name:VARVIS, NATHAN T (MA)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:T
Last Name:VARVIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39900 VIEW RD # 2
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3037
Mailing Address - Country:US
Mailing Address - Phone:559-286-8593
Mailing Address - Fax:
Practice Address - Street 1:1950 MARKET ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1720
Practice Address - Country:US
Practice Address - Phone:951-530-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT136407106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist