Provider Demographics
NPI:1972191906
Name:MORRISSEY, NATHAN TYLER (LPC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:TYLER
Last Name:MORRISSEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 NAOMI ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3618
Mailing Address - Country:US
Mailing Address - Phone:610-704-0165
Mailing Address - Fax:
Practice Address - Street 1:1929 LINCOLN HWY E STE 150
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3685
Practice Address - Country:US
Practice Address - Phone:717-397-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional