Provider Demographics
NPI:1184118705
Name:KEYSE, NATHANIEL DAVID (LPCC, LICDC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DAVID
Last Name:KEYSE
Suffix:
Gender:M
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 CHANTILLY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5707
Mailing Address - Country:US
Mailing Address - Phone:513-317-7785
Mailing Address - Fax:
Practice Address - Street 1:5771 HAMILTON CLEVES RD
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002
Practice Address - Country:US
Practice Address - Phone:513-285-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161449101YA0400X
OHE.1800700101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health