Provider Demographics
NPI:1700883626
Name:NATHAN, STUART JOEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JOEL
Last Name:NATHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:J
Other - Last Name:NATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2450 FONDREN RD
Mailing Address - Street 2:#312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2323
Mailing Address - Country:US
Mailing Address - Phone:713-789-7560
Mailing Address - Fax:713-789-7351
Practice Address - Street 1:2450 FONDREN RD
Practice Address - Street 2:#312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2318
Practice Address - Country:US
Practice Address - Phone:713-789-7560
Practice Address - Fax:713-789-7351
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23367101YP2500X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032002004Medicaid
TX23367OtherMOLINA/COMPCARE
TX23367OtherTRICARE
TX4526527OtherAETNA
TX146554401Medicaid
TX23367OtherLIFESYNCH HUMANA
TX23367OtherMAGELLAN
TX23367OtherAPS
TX23367OtherMHN
TX23367OtherMULTIPLAN/PHCS
TX23367OtherRENNASCIANCE
TX23367OtherUBH
TX680001954OtherRR MEDICARE
TX00B06AOtherBCBS
TX026280OtherVALUE OPTIONS
TX10019555OtherAMERIGROUP
TX23367OtherGREAT WEST
TX23367OtherONE HEALTH
TX23367OtherTEXAS TRUE CHOICE
TX23367OtherCIGNA
TX78170308OtherUNICARE
TX10019555OtherAMERIGROUP