Provider Demographics
NPI:1760925606
Name:WEBB, NATHANIEL
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:WEBB
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 1:930 VIA CANALE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0828
Mailing Address - Country:US
Mailing Address - Phone:702-326-7750
Mailing Address - Fax:702-948-4905
Practice Address - Street 1:930 VIA CANALE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-0828
Practice Address - Country:US
Practice Address - Phone:702-326-7750
Practice Address - Fax:702-948-4905
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1701517598106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician