Provider Demographics
NPI:1922470947
Name:CHURCH, NATHAN (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:CHURCH
Suffix:
Gender:M
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-6844
Mailing Address - Country:US
Mailing Address - Phone:951-663-2070
Mailing Address - Fax:
Practice Address - Street 1:43585 MONTEREY AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9342
Practice Address - Country:US
Practice Address - Phone:760-777-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1744R1102XOther Service ProvidersSpecialistResearch Study
No174H00000XOther Service ProvidersHealth Educator
No174V00000XOther Service ProvidersClinical Ethicist