Provider Demographics
NPI:1780412999
Name:MYLIE, NATHAN C (CSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:MYLIE
Suffix:
Gender:M
Credentials:CSW
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 66558
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6558
Mailing Address - Country:US
Mailing Address - Phone:225-922-2700
Mailing Address - Fax:225-362-5319
Practice Address - Street 1:422 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6505
Practice Address - Country:US
Practice Address - Phone:225-922-0478
Practice Address - Fax:888-965-7288
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker