Provider Demographics
NPI:1659478204
Name:NATHAN, ALISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:680 LANGSDORF DR
Mailing Address - Street 2:# 219
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3702
Mailing Address - Country:US
Mailing Address - Phone:714-871-9732
Mailing Address - Fax:714-871-4561
Practice Address - Street 1:680 LANGSDORF DR
Practice Address - Street 2:# 219
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:714-871-9732
Practice Address - Fax:714-871-4561
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical