Provider Demographics
NPI:1023325636
Name:FITCH, NATHAN DEAN (LMFT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:DEAN
Last Name:FITCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 MEDICAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5657
Mailing Address - Country:US
Mailing Address - Phone:210-280-0262
Mailing Address - Fax:210-615-1122
Practice Address - Street 1:4115 MEDICAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5657
Practice Address - Country:US
Practice Address - Phone:210-280-0262
Practice Address - Fax:210-615-1122
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10742101YA0400X
TX201209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)