Provider Demographics
NPI:1790795607
Name:DENNY, NATHAN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:DENNY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14079 LAKEPOINT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-3269
Mailing Address - Country:US
Mailing Address - Phone:808-372-7339
Mailing Address - Fax:
Practice Address - Street 1:14079 LAKEPOINT DR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-3269
Practice Address - Country:US
Practice Address - Phone:808-372-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical