Provider Demographics
NPI:1821317983
Name:OLIVER, NATHAN JACKSON (LMHC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JACKSON
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6275
Mailing Address - Country:US
Mailing Address - Phone:561-622-1771
Mailing Address - Fax:
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-622-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health