Provider Demographics
NPI:1467512780
Name:GALBREATH, NATHAN WAYNE (PHD, MFS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WAYNE
Last Name:GALBREATH
Suffix:
Gender:M
Credentials:PHD, MFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11923 28TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2415
Mailing Address - Country:US
Mailing Address - Phone:701-723-5531
Mailing Address - Fax:701-723-5225
Practice Address - Street 1:10 MISSLE AVE
Practice Address - Street 2:5 MDOS SGOH
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58705-5003
Practice Address - Country:US
Practice Address - Phone:701-723-5531
Practice Address - Fax:701-723-5525
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical