Provider Demographics
NPI:1780137141
Name:AISH, NATHAN (LCSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:AISH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:#998
Mailing Address - City:TECATE
Mailing Address - State:CA
Mailing Address - Zip Code:91980
Mailing Address - Country:US
Mailing Address - Phone:619-952-3404
Mailing Address - Fax:
Practice Address - Street 1:451 TECATE RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:TECATE
Practice Address - State:CA
Practice Address - Zip Code:91980
Practice Address - Country:US
Practice Address - Phone:619-259-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008491041S0200X, 1041C0700X, 101YM0800X
CAASW62577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health