Provider Demographics
NPI:1952604589
Name:HOUSE, NATHANIEL GRANT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:GRANT
Last Name:HOUSE
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 1:2310 RUTGER ST APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2443
Mailing Address - Country:US
Mailing Address - Phone:314-599-6584
Mailing Address - Fax:
Practice Address - Street 1:8008 CARONDELET AVE STE 308
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1724
Practice Address - Country:US
Practice Address - Phone:314-391-8030
Practice Address - Fax:833-969-0194
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL1490180271041C0700X
MO20170160251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker