Provider Demographics
NPI:1629633805
Name:TAYLOR, NATHANIEL DAVID (LIMHP)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DAVID
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 O ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1385
Mailing Address - Country:US
Mailing Address - Phone:402-450-8645
Mailing Address - Fax:
Practice Address - Street 1:6 MANOR PKWY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2841
Practice Address - Country:US
Practice Address - Phone:866-957-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2208101YM0800X
NH2488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health