Provider Demographics
NPI:1841068871
Name:LAUSCH, NATHAN JOEL
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOEL
Last Name:LAUSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 N 6000 W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3048
Mailing Address - Country:US
Mailing Address - Phone:360-790-8553
Mailing Address - Fax:
Practice Address - Street 1:1920 E 17TH ST STE 330
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8036
Practice Address - Country:US
Practice Address - Phone:208-534-8303
Practice Address - Fax:208-277-2202
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker