Provider Demographics
NPI:1720269392
Name:NATHE, AMY (LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NATHE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MN
Mailing Address - Zip Code:56547-9565
Mailing Address - Country:US
Mailing Address - Phone:701-212-2758
Mailing Address - Fax:
Practice Address - Street 1:26246 CRANE RD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-9998
Practice Address - Country:US
Practice Address - Phone:218-983-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional