Provider Demographics
NPI:1639529258
Name:SUTHERLAND, NATE JOHN
Entity Type:Individual
Prefix:
First Name:NATE
Middle Name:JOHN
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37770 UPPER CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-8753
Mailing Address - Country:US
Mailing Address - Phone:541-345-0805
Mailing Address - Fax:541-345-0855
Practice Address - Street 1:37770 UPPER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478
Practice Address - Country:US
Practice Address - Phone:541-345-0805
Practice Address - Fax:541-345-0855
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst