Provider Demographics
NPI:1568462844
Name:GOTTLIEB, HARRIS NATHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:NATHAN
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:LMFT
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 1509
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1509
Mailing Address - Country:US
Mailing Address - Phone:678-352-0860
Mailing Address - Fax:678-352-0760
Practice Address - Street 1:11111 HOUZE RD
Practice Address - Street 2:STE 225
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5663
Practice Address - Country:US
Practice Address - Phone:678-352-0860
Practice Address - Fax:678-352-0760
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist